Abstract
T-cell acute lymphoblastic leukemia (T-ALL) with coexisting SIL-TAL1 fusion and t(11;14)(p15;q11.2) is exceedingly rare. There are limited data on the clinical course and outcomes of such patients. We report a case of a 19-year-old male presenting with aggressive T-ALL harboring these abnormalities, along with NOTCH1 and PTEN mutations. SIL-TAL1 positivity is associated with poor prognosis in T-ALL. Despite achieving remission with intensive chemotherapy, the patient experienced rapid relapse and poor overall survival, reflecting the ineffectiveness of conventional treatments. The findings highlight the synergistic role of SIL-TAL1 and t(11;14) in disease progression and underscore the urgent need for targeted therapies and immunotherapies to improve outcomes in such high-risk cases.