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However, for noninfant patients with B-ALL, combined relapses were associated with a better outcome, compared with isolated marrow relapses.[15] Time from diagnosis to relapse In general, patients whose relapses occur earlier after initial diagnosis fare worse than those who experience later relapses.[15] For example, survival rates for patients with relapsed B-ALL range from less than 20% for patients with marrow relapses occurring within 18 months from diagnosis to higher than 60% for those whose relapses occur more than 36 months from diagnosis.[5,13,18] For patients with isolated central nervous system (CNS) relapses, the overall survival (OS) rates are 40% to 50% for early relapse ( 18 months from diagnosis).[13,19] No evidence exists that early detection of relapse by frequent surveillance (complete blood counts or bone marrow tests) in off-therapy patients improves outcome.[20] Patient characteristics Age 10 years and older at initial diagnosis and at relapse have been reported as independent predictors of poor outcome.[13,17] A COG study demonstrated that patients aged 10 to 15 years at initial diagnosis had inferior outcomes compared with patients aged 1 to 9 years (5-year postrelapse survival rate, 36% vs

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