Background: Expression of ATB-binding cassette (ABC) transporters could be correlated with drug resistance and treatment failures like recurrence in pediatric patients with acute lymphoblastic leukemia (ALL). The relation of ABC gene expression and relapse in ALL is still unclear. This might be important especially in regions with a high rate of relapse. Objectives: This study aimed to evaluate the role of ABCG1, ABCG2, and ABCB1 gene expression in the recurrence of Iranian pediatric patients with ALL. Methods: Iranian pediatric patients with confirmed ALL were enrolled in this study as two groups; relapsed ALL and a control group consisting of 3 years relapse-free survival (RFS). Real Time-PCR was done with GAPDH for expressing ABCG1, ABCG2, and ABCB1 transporter genes. Cumulative doses of VCR (vincristine), DNR (daunorubicin), and L-ASP (L-asparaginase) were calculated for each patient. The gathered data were analyzed with SPSS version 22 and REST 2009 software. Results: Total of 39 samples (23 cases; 16 controls) were enrolled during 26 months. High expression of ABCG1 (P value = 0.0068), ABCG2 (P value = 0.0120) and low expression of ABCB1 (P value = 0.0029) related with conferring increased risk of relapse in the patients. The mean relative folds of expressions were 2.3, 1.8, and 1.07 for ABCG1, ABCG2, and ABCB1, respectively. In addition achieved expression pattern was related to high doses of VCR, DNR, and L-ASP. Conclusions: Designed expression pattern have the predictive value for estimating of conferring relapse in Iranian pediatric patients with diagnosed ALL.