Rare anomalies in childhood ALL are near-tetraploidy (82–94 chromosomes), which was observed in ETV6::RUNX1+ ALL by Attarbaschi et al. The authors did not explain whether tetraploidization also is such a comparatively early evolutionary step that merely promotes the malignant potential of ETV6::RUNX1+ blast cells, or whether it is actually rather a late event or even the last trigger that sets off the clinical disease manifestation [60]. This evidence concerns the gene ETV6 and acute lymphoblastic leukemia.