A 5-year old white boy is referred to the pediatric oncology clinic after presenting to his local pediatrician with a 4-day history of fever and respiratory symptoms. On examination, the advanced practice nurse (APN) finds the patient to have pallor with cervical adenopathy. Complete blood count was significant for white count of 21,000/mm3, hemoglobin of 7.2 g/dl, and platelets of 102,000/mm3. Diagnostic bone marrow aspirate and lumbar puncture were completed upon presentation, and the patient was found to have pre-B-cell ALL. The cytogenetic analysis of the leukemia found the most common chromosome number within the leukemia blast to be 52 chromosomes and classified as hyperdiploid. Lastly, the cytogenetic and molecular analysis found no translocation within the leukemia blast.