Although IKZF1 alterations are associated with poor outcome overall in ALL (6, 9, 11, 20–28), and several reports suggest that the IKZF1plus genotype identifies a higher risk group of patients than those with IKZF1 alterations alone (7, 18, 19), the relationship between IKZF1 alterations and outcomes remains incompletely understood for several reasons. Here, IKZF1 is linked to acute lymphoblastic leukemia.