The patient's RTEL1 variant was inherited from mother, who has VLTL in the granulocyte compartment and low TLs in lymphocytes, native T cells, memory T cells, and B cells, which could be consistent with the patient's mother either having TBD or being a carrier of TBD, with possible anticipation occurring in our patient who has history of cancer, MDS, and VLTL [1]. The gene discussed is RTEL1; the disease is myelodysplastic syndrome.