ALK can also be activated by genomic focal amplification, described in 1%-2% of NBs, almost exclusively with MNA,17,24 or, more rarely, following structural rearrangements.25 Genetic alterations of ALK are associated with poorer survival in the overall NB population.24,26 However, their prognostic role in HR-NB has been less well studied.10,17,24 Altogether, ALK alterations are an important molecular target, given the role of ALK as a driver oncogene in NB and its actionability with small molecule therapies.27-29. This evidence concerns the gene ALK and Nijmegen breakage syndrome.