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Monthly landmark\u2010based Cox analyses identified 13\u2009months as the time point with the peak hazard ratio (HR\u2009=\u200931.97) and 27\u2009months as the time point with the maximum \u2212log10P value (158.08); given the small differences from 12 and 24\u2009months and their greater clinical practicality, POD12 (progression of disease within 12\u2009months) and POD24 (progression of disease within 24\u2009months) were selected as clinically practical landmarks for subsequent analyses. In the TARGET and MP2PRT cohorts, POD12 occurred in 2.56% of patients and POD24 in 8.67%. Patients with POD12 had a 5\u2010year overall survival (OS) of 11.13% versus 90.89% in non\u2010POD12 patients, whereas patients with POD24 had a 5\u2010year OS of 36.19% versus 93.62% in non\u2010POD24 patients. In all four external validation cohorts, POD12 and POD24 were likewise associated with significantly inferior OS compared with their respective non\u2010POD groups. In univariate analyses, E2A\u2010PBX1 and MLL rearrangements were associated with increased risk of POD12 and POD24. These findings support POD12 and POD24 as clinically practical, data\u2010driven landmarks for identifying patients with adverse survival outcomes. They may also inform the exploratory evaluation of 1\u2010year and 2\u2010year progression\u2010free survival as hypothesis\u2010generating candidate early trial endpoints, pending prospective validation.<\/jats:p>","DOI":"10.1002\/ajh.70432","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:54:10Z","timestamp":1782917650000},"page":"2329-2342","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relapse Thresholds (12\/24 Mo) Define Survival Disparity in Pediatric B\u2010\n                    <scp>ALL<\/scp>"],"prefix":"10.1002","volume":"101","author":[{"given":"Binjun","family":"Xiong","sequence":"first","affiliation":[{"name":"Precision Oncology and Intelligent Theranostics Laboratory Children's Hospital of Chongqing Medical University  Chongqing China"},{"name":"Ministry of Education Key Laboratory of Child Development and Disorders National Clinical Research Center for 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