Interestingly three of our four cases, and two published previously [33], co-occurred with amplification of Xq, adding to six reported examples of unbalanced translocations and variable breakpoints, resulting in partial loss of 6q and gain of Xq [der(6)t(X;6)] in ETV6::RUNX1-ALL [34–36]. The gene discussed is ETV6; the disease is acute lymphoblastic leukemia.