Background: Remarkable progress has been made in the treatment of pediatric acute lymphoblastic leukemia (ALL), with survival rates reaching > 80% in high-income countries. In Egypt, the outcome of treatment of ALL has been less favorable. Aim: To evaluate the clinicolaboratory characteristics in patients admitted at Sohag Cancer Center and to assess the outcome and the prognostic factors affecting it. Methods: This retrospective study included 79 pediatric ALL patients, from January 2010 to December 2014, who were treated according to modified Total therapy study XIIIB high-risk ALL of St. Jude Children's Research Hospital (SJCRH). Results: 52% were males with a median age of 6 years. 58.2% were stratified as HR, 69.6% had precursor B-ALL, 39.2% presented with total leucocytic count (TLC) (≥ 50x109/L), and 11.3% had CNS leukemia. Complete remission (CR) was achieved in 87.3%. Regarding treatment outcome, induction failure was reported in 5.1%, relapse in 24.1%, deaths in CR in 7.2%, and continuous complete remission in 59.5%. The median follow-up was 42 months, 4 years OS, EFS, and DFS were 64.1 ± 5.6, 57 ± 5.7, and 63.3 ± 5.8% respectively. TLC and bone marrow aspirate postinduction were the only significant prognostic factors affecting EFS. Conclusions: The modified TXIIIB of SJCRH was effective in improving ALL outcomes in our center, however, survival rates were much lower than internationally reported results with only initial TLC and response postinduction having a significant effect on EFS and DFS.