SummaryThe IKZF1 gene at 7p12.2 codes for IKAROS (also termed IKZF1), an essential transcription factor in haematopoiesis involved primarily in lymphoid differentiation. Its importance is underlined by the fact that deregulation of IKAROS results in leukaemia in both mice and men. During recent years, constitutional as well as acquired genetic changes of IKZF1 have been associated with human disease. For example, certain germline single nucleotide polymorphisms in IKZF1 have been shown to increase the risk of some disorders and abnormal expression and somatic rearrangements, mutations and deletions of IKZF1 (DIKZF1) have been detected in a wide variety of human malignancies. Of immediate clinical importance is the fact that DIKZF1 occurs in 15% of paediatric B-cell precursor acute lymphoblastic leukaemia (BCP ALL) and that the presence of DIKZF1 is associated with an increased risk of relapse and a poor outcome; in some studies such deletions have been shown to be an independent risk factor also when minimal residual disease data are taken into account. However, cooperative genetic changes, such as ERG deletions and CRLF2 rearrangements, may modify the prognostic impact of DIKZF1, for better or worse. This review summarizes our current knowledge of IKZF1 abnormalities in human disease, with an emphasis on BCP ALL.Keywords: IKZF1, deletion, mutation, leukaemia, prognosis.The zinc finger protein IKAROS (also termed IKZF1) is encoded by the IKZF1 gene, located in chromosome subband 7p12.2 (chr7:50,304,124-50,405,101; http://www.ensembl.org/index.html) and was first identified in 1992 as an important transcription factor for the maturation of T lymphocytes in mice (Georgopoulos et al, 1992); however, an isoform of this protein, LyF-1, had previously been reported as an essential player in the regulation of both T-and B-cell lineage specification (Lo et al, 1991).In the mid-and late-1990s, mutations of IKZF1 or abnormal expression of IKAROS were, for the first time, implicated in leukaemia and numerous subsequent studies have since addressed the pathogenetic and clinical impact of IKA-ROS and its various isoforms in human disease, revealing, for example, that germline single nucleotide polymorphisms (SNPs) in IKZF1 are associated with increased (or decreased) susceptibility to certain disorders, that a constitutional IKZF1 deletion (DIKZF1) may increase the risk of developing acute lymphoblastic leukaemia (ALL), that aberrant expression and hypermethylation of IKZF1 occurs in some solid tumours, that IKZF1 is rearranged due to translocations in a few haematological malignancies, that sequence mutations of IKZF1 (mutIKZF1) are present in both solid tumours and leukaemia, and that DIKZF1 is common in chronic myeloid leukaemia (CML) in lymphoid blast crisis and in adult and paediatric B-cell (BCP) ALL. These findings will be reviewed herein, with a focus on IKZF1 abnormalities in BCP ALL.