A 21-year-old woman was diagnosed with B lineage acute lymphoblastic leukemia (ALL) after presenting to a community-based medical oncologist with fatigue, fevers, and pancytopenia (white blood cell count 2.3 103/ L, hemoglobin 8 g/dL, platelets 42 103/L). She was transferred to a regional children’s hospital to institute therapy. Cytogenetics showed 55, XX, 4, 6, 10, 14, 17, 18, 21, 21[8]/46, X...