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en Impact of Gene Expression of TLR4, TLR7, and TLR9 in Children with Acute Lymphocytic Leukemia in Basrah Aims: Acute lymphoblastic leukemia (ALL) is the most prevalent malignancy in children, accounting for up to 25% of all malignancies in children under the age of 15. TLRs are associated with the transduction of molecular signals in immune processes such as the production of cytokines, and recognition of specific molecular patterns on the surface of microorganisms, but they are also involved in cancer development. This study was trying to throw light on any possible association of gene expression of TLR4, TLR7, and TLR9 in pediatric patients with ALL. Materials & Methods: A case-control study was conducted on pediatric patients with ALL who have been admitted to Al-Basra Children Teaching Specialty Hospital. Over a period from September 2020 through June 2021, 62 patients (42 newly diagnosed and 20 relapses) were enrolled, in addition to 60 matched normal control, aged 6 months to 16 years. Three ml of blood was collected from all participants in EDTA tubes used for RNA extraction and then molecular analysis. Gene expression of TLR4, TLR7, and TLR9 was done by Real Time-qPCR and the results were reported as ∆Ct (mean±SD). Findings: The mean ∆Ct of TLR7 (-5.2200±3.29806) reflects the high expression of the gene being the most highly expressed gene (p<0.001). The mean ∆Ct±SD of TLR7 and TLR9 are high in a newly diagnosed group than relapsed one with no significant differences (p=0.686, and 0.400) respectively, while the mean ∆Ct of TLR4 is higher significantly (p<0.05) in a newly diagnosed group than relapsed one. Conclusion: TLR4, TLR7, and TLR9 gene expression are higher in ALL patients, whether newly diagnosed or relapsed than in the control group. TLRs expression might be part of the immune-evasion mechanism developed by the malignant cells that play an important role in leukemogenicity and disease progression. Quantitative Real Time PCR,Toll-Like Receptors,ALL Childhood, 75 81 http://ijwph.daneshafarand.org/browse.php?a_code=A-10-1936-1&slc_lang=en&sid=3 R.A. Mustafa 1003194753284600378393 1003194753284600378393 No Department of Microbiology, College of Medicine, University of Basrah, Basrah, Iraq H.A. Jasim 1003194753284600378392 1003194753284600378392 Yes Department of Microbiology, College of Medicine, University of Basrah, Basrah, Iraq S.Kh. Al-Salait 1003194753284600378391 1003194753284600378391 No Department of Pathology, Al-Zahraa Medical College, University of Basrah, Basrah, Iraq