The genetic mutations are diverse in B-ALL and include: (1) Transcriptional factors promoting early lymphoid cell development, such as PAX5, IKZF1, EBF1, ETV6, ERG, GATA3, and LMO2. (2) Tumor suppressor genes and cell cycle regulators, such as TP53, RB1, and CDKN2A/CDKN2B, BAK1. (3) Cytokine receptors, such as CRLF2, RPOR (4) Kinases, such as ABL1, ABL2, CSF1R, JAK2, PDGFRB. (5) Ras signaling pathway genes, such as KRAS, NF1, NRAS, PTPN11. (6) Lymphoid signaling genes, such as BTLA, and CD200, and (7) Epigenetic modifiers, such as EZH2, CREBBP, SETD2, MLL2, and NSD2. The gene discussed is CREBBP; the disease is precursor B-cell acute lymphoblastic leukemia.