Our knowledge of early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is advancing, as highlighted by an excellent talk on the topic at the 1st International Workshop on Acute Leukemias (iwAL), held in St. Pete Beach, FL. Speaking from the meeting, Bijal Shah, MD, of the H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, discusses his thoughts on the diagnosis of ETP-ALL. He highlights the fact that immunophenotypical methods may be insufficient alone in this diagnosis, discussing recent study data investigating the molecular biology of the disease.