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Although marked advances have occurred during the last 30 years in the treatment of pediatric patients with acute lymphoblastic leukemia (ALL), infants who are diagnosed with ALL still have relatively poor prognoses and survival rates that lag behind those of children who are diagnosed later (age, >1 year). Despite complete remission rates for infant ALL that are consistently higher than 90% in published studies, long-term event-free survival rates rarely exceed 45%. Unlike older children, infants who are diagnosed with ALL often have extremely high white blood cell counts (>300×109/L) and translocations that involve the mixed-lineage leukemia (MLL) gene on chromosome 11 (11q23). The most common mutation is t(4;11), especially among infants…