After two cycles of hyper-CVAD-L, 19.5% lymphoblastic leukemia cells remained in bone marrow, which carried the same mutations in ASXL1 (11.5%; NM_015338.6: exon12: c.1934dupG: p. Gly646fs rs1085307856), PTPN11 (10.38%; NM_002834: exon3: c.182 A > T: p. Asp61Val rs121918461), RUNX1 (13.4%; NM_001754: exon9: c.1274 C > T: p. Pro425Leu), and U2AF1 (12.86%; NM_006758: exon2: c.101 C > T: p. Ser34Phe rs371769427) genes, indicating a failure to induction therapy. Here, RUNX1 is linked to acute lymphoblastic leukemia.