Improved insight into cancer cell populations responsible for relapsed disease will lead to better outcomes for patients. Here, we report a single-cell study of B-cell precursor acute lymphoblastic leukemia at diagnosis that revealed hidden developmentally dependent cell signaling states uniquely associated with relapse. With mass cytometry, we simultaneously quantified 35 B-cell developmental proteins in 60 primary diagnostic samples. Each leukemia cell was then matched to it’s nearest healthy B-cell population by a developmental classifier that operated at the single-cell level. Machine learning identified 6 features of expanded leukemic populations sufficient to predict patient relapse at diagnosis. These features implicated pro-BII cells with activated mTOR signaling, and pre-BI cells with activated and unresponsive pre-B-cell receptor signaling, to be associated with relapse. This model, termed Developmentally Dependent Predictor of Relapse (DDPR), significantly improves currently established risk stratification methods. DDPR features exist at diagnosis and persist at relapse. Leveraging a data-driven approach, we demonstrate the predictive value of single-cell ‘omics’ for patient stratification in a translational setting and provide a framework for application in human cancers.