Classification of myeloproliferative neoplasms is based on hematologic, 
histopathologic, and molecular characteristics, including the BCR-ABL1 and JAK2 
V617F or MPL and CALR. Although the different gene mutations ought to be 
mutually exclusive, several cases with co-occurring BCR-ABL1 and JAK2 V617F or 
CALR have been identified with a frequency of 0.2-2.5% in the European 
population. The tyrosine kinase abnormalities appeared to affect independent 
subclones because imatinib mesylate (IM) treatment induced Ph+-CML remission, 
whereas the JAK2V617F clone either persisted or clinically expanded after a 
major response of Ph+-clone. Allogeneic stem cell transplantation is at present 
the only potentially curative therapy for these patients after therapy with 
ruxolitinib and TKI inhibitor. We describe the case of 3 young people treated in 
our institution for the coexistence of BCR/ABL chronic myeloid leukemia and 
another Philadelphia chromosome-negative (Ph-) Chronic myeloproliferative 
disease. They received ruxolitinib, imatinib/nilotinib, and allogeneic 
transplantation with safe and efficient results.