Altered metabolism of fatty acid synthesis is considered a hallmark characteristic of several malignancies, including acute lymphoblastic leukemia (ALL). to evaluate the impact of fatty acid synthase (FASN) on drug resistant ALL, bone marrow samples were collected from 65 pediatric ALLs, including 40 de novo and 25 relapsed patients. 22 non-cancer individuals were chosen as controls. Quantitative RT-PCR showed increased expression levels of FASN in drug resistant patients compared with the therapy responders. Single and combined treatment of malignant cells were analyzed using Annexin-V/PI double staining and MTT assays. Incubation of resistant primary cells with ginger showed simultaneous increased apoptosis rates and reduced FASN expression levels. Furthermore, docking studies demonstrated high affinity bindings between ginger derivatives and FASN thioesterase and ketosynthase domains, compared with their known inhibitors, fenofibrate and morin, respectively. Finally, combined treatment of in-house multidrug resistant TALL subline with ginger and dexamethasone induced drug sensitivity and down regulation of FASN expression, accordingly. To the best of our knowledge, this is the first study that introduces FASN upregulation as a poor prognostic factor for drug resistant childhood ALL. Moreover, it was revealed that fASn inhibition may be applied by ginger phytochemicals and overcome dexamethasone resistance, subsequently. Acute lymphoblastic leukemia (ALL) is the most common type of hematological malignancy in children 1,2. Despite the enormous advances in modern medicine and development of innovative therapeutic strategies, disease relapse remains a leading cause of cancer-related morbidity and mortality in children 3. Metabolic rearrangements are vital to satisfy the different requirements of cancer cells during tumorigenesis 4. Elevated de novo fatty acid biosynthesis is a hallmark adaptation in many cancers that supply signaling molecules and basic elements for lipid biosynthesis 5. While most normal cells supply their fatty acids from dietary sources, cancer cells reactivate de novo fatty acid synthesis 6. Fatty acid synthase (FASN) is a multifunctional protein containing six enzymatic domains that catalyzes the biosynthesis of palmitate 5. Elevated expression of FASN is found to be associated with poor prognosis and higher risk of recurrence in a number of human cancers. Indeed, FASN overexpression has been shown to contribute to multidrug resistance (MDR). Multi-drug resistance is one of the major obstacles to the successful treatment of various types of cancer, particularly childhood ALL 5,7,8. Glucocorticoids (GCs) such as prednisone and dexamethasone (DEX) are indispensable drugs for childhood ALL treatment 9. Early response to glucocorticoids is a positive prognostic indicator and glucocorticoid resistance has been associated with an increased risk of relapse and poor clinical response 10,11. Glucocorticoids regulate FASN expression and subsequently affect lipogenesis 12. Therefore, FASN knock down or...