Few patients (7.9%; 157/1,979) demonstrate disease progression or relapse.13 Consistent with the World Health Organization consensus, which classified BL as a leukemic variant of Burkitt lymphoma, the TPOG treats patients with BL using the TPOG 10 B-NHL-R4 protocol.5 By contrast, patients with other forms of B-cell ALL are treated using the ALL protocol.14 However, TCF3-HLF-positive ALL is highly resistant to conventional chemotherapy and has a high rate of treatment failure despite treatment intensification and hematopoietic stem cell transplantation.6 This evidence concerns the gene HLF and acute lymphoblastic leukemia.