The patient is a 36-year-old gentleman with relapsed APL referred to our institute for further management. A detailed history revealed that the patient was first presented with fever and rash in February 2016 and morphological features on peripheral smear raised the suspicion of APL. However, PML-RARA was not detected by molecular testing (details of PML-RARA or variant RARA testing not available). The patient was started on induction therapy with daunorubicin and cytarabine followed by three cycles of HiDAC. The patient achieved remission after the 1st cycle of HiDAC. He also received two cycles of decitabine and arsenic trioxide before being referred to us. The patient relapsed in January 2017 with confirmation of t(11;17) by FISH. On presentation, the patient was asymptomatic and clinical examination did not show any abnormality. CBC and FCI findings are detailed in Table 1. Bone marrow smears showed 22% abnormal promyelocytes and 33% differentiating myeloid cells. Morphological features of the abnormal promyelocytes were similar to case 1. Immunophenotype was similar to case 1 except the CD117 expression in the present case. PCR was used to confirm the presence of ZBTB16-RARA fusion. Baseline Ct value by RT-qPCR was 21.39. The patient was counseled for bone marrow transplantation but was put on palliative care, given non-affordability for transplantation.