The whole-genomic sequencing analysis highlighted also that ATRX mutations, which define another high-risk subgroup, occur only in MYCN-non-amplified and TERT-normal NB, and are associated with alternative lengthening of telomeres (ALT) activity.20 This observation suggests that telomere lengthening is a common trait of high-risk NB (i.e., TERT-rearranged, MYCN-amplified and ATRX-mutated tumors) regardless of the mechanism that is utilized for telomere maintenance. Here, ATRX is linked to neuroblastoma.