The incidence of liver failure associated with asparaginase was only 1.8%, similar to the 1% reported in the study of Advani et al. [31] Although liver failure is rare, it led to the death of three patients, two of whom had favorable prognostic factors for the underlying disease (TEL-AML1 rearrangement and age < 6 years). Here, RUNX1 is linked to liver failure.