Neuroblastoma is responsible for 15% of cancer deaths in children younger than 5 years of age. Because of its heterogeneous clinical course (from spontaneous regression to incurable high-risk disease), it is essential to stratify patients so that the right course of action can be taken. Viprey et al. have identified three types of mRNAs (PHOX2B, tyrosine hydroxylase [TH], and doublecortin [DCX]) that can be detected in peripheral blood and bone marrow. In a cohort of 290 children, high levels of these mRNAs at diagnosis identified those children with ultra high-risk disease who would benefit from new and more-aggressive treatments.