The possible involvement of cancer-predisposing genes not included in our target panel cannot be ruled out, but germline mutation was not found in common oncogenes, including BRCA1, BRCA2, TP53, DDX41, RUNX1, ANKRD26, and ETV6. Recent study reported a tr-ALL case in Li-Fraumeni syndrome patient 6. Here, DDX41 is linked to acute lymphoblastic leukemia.