Background: While numerous studies have addressed the outcome of childhood acute lymphoblastic leukemia (ALL) in western developed countries, there is a scarcity of data in developing countries. This study explores the hematological predictors of outcomes in childhood acute lymphoblastic leukemia in Duhok city-Kurdistan Iraq. Method: the current study represents a cross-sectional study, conducted in Hivi Pediatric hospital and Zheen oncology center in Duhok, Iraq, and 116 patients were enrolled. The main features of childhood ALL, hematological predictors, type of therapy, and risk factors were analyzed to assess their effect on treatment outcome and survival rate. Results: Median age of the study cohort was 5 years and the male-to-female ratio of 1.4:1. 87.9% of the cases were B-ALL while 12.1 were T-cell. Blood counts revealed a mean WBC count of 54.34 x 109/L, mean hemoglobin of 7.913 g/dl, and mean platelet count of 68.96 x 109/L. Complete remission (CR) rate was 92.2%, the overall 5-year survival (OS) was 76.7%, and relapse-free 5-year survival (RFS) was 73.3%. Patients with B-cell ALL had significantly higher OS compared to patients with T-cell (p value=0.01). Patients stratified into high-risk groups had significantly lower RFS and OS compared to the intermediate and standard risk groups (p value=0.04, 0.008 respectively). Patients aged >10 years had significantly lower RFS (p value=0.001). Other factors such age<1 year, PLT count, Hb count, and gender did not predict poor outcome Conclusion: Immunophenotype, age>10 years and risk stratification are important predictors of outcome in childhood ALL in our study, most notably, the patients' survival rates were inferior to similar reports from western developed countries, The key areas for future work should include wider implementation of MRD and cytogenetic analysis in risk stratification to improve the outcome of childhood ALL.