Notch3 and Notch4 support survival of primary B-cell acute lymphoblastic leukemia (B-ALL) cells, suggesting a role for Notch signaling in drug response. Here we used in vitro, in silico, and in vivo mouse xenograft model-based approaches to define the role of the Notch pathway in BALL chemosensitivity. We observed significant Notch receptor and ligand expression in BALL primary cells and cell lines. Primary leukemia cells from high-risk patients overexpressed Notch3, Notch4, and Jagged2 while displaying a reduction in expression levels of Notch1-4 following chemotherapy. We then analyzed in vitro cell survival of BALL cells treated with conventional chemotherapeutic agents alone or in combination with Notch signaling inhibitors. Gamma-secretase inhibitors (GSI) and anti-Notch4 were all capable of potentiating drug-induced cell death in BALL cells by upregulating intracellular levels of reactive oxygen species, which in turn modulated mTOR, NF-kB, and ERK expression. In NOG-mouse-based xenograft models of BALL , co-administration of the Notch inhibitor GSI-XII with the chemotherapeutic agent Ara-C lowered bone marrow leukemic burden compared with DMSO or Ara-C alone, thus prolonging mouse survival. Overall, our results support the potential effectiveness of Notch inhibitors in patients with BALL. Significance: Inhibition of Notch signaling enhances the chemosensitivity of BALL cells, suggesting Notch inhibition as a potential therapeutic strategy to improve the outcome of patients with BALL .