Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a subgroup of T-cell acute lymphoblastic leukemia (T-ALL) that shares similarities with both T-ALL and acute myeloid leukemia (AML). We present a unique case of pediatric ETP-ALL with a t(6;11)(q27;q23)/KMT2A-AFDN translocation in which leukemia cells underwent lineage conversion to AML during ALL induction chemotherapy in order to demonstrate the lineage plasticity of T/myeloid progenitor cells in ETP-ALL patients.