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Charles Mullighan, MBBS (Hons), MSc, MD, from St. Jude Children’s Research Hospital, Memphis, TN, outlines how genomics has revised the molecular classification of acute lymphoblastic leukemia (ALL) at the International Symposium on Acute Leukemias (ISAL) 2017 in Munich, Germany. He discusses the identification of multiple subtypes of leukemia, each of which has implications for how we understand leukemia so far, as well as how it can be diagnosed and treated. Dr Mullighan also describes studies of larger cohorts of ALL patients across an age range from children to older adults, which gives us a clearer understanding of the variations and prevalence of different subtypes. He points out that particularly some of the newly identified subtypes are more common in older adults than children, which may partially account for the poor outcomes with therapy.