Introduction and objectives: Acute lymphoblastic leukemia (ALL) in pediatric patients is an issue that affects the quality of life of the patient and his family, so it is urgent to know the physiology, presentation, and functionality of the cell population that allows determining the more effective treatments. The objective is to review the evidence derived from cohort studies and clinical trials on ALL in pediatric patients. Method: A retrospective study carried out based on the search for cohort studies and clinical trials in the last 10 years in MEDLINE, EMBASE, and Cochrane Controlled Trials Register whose keywords [Acute and Lymphoblastic Leukemia], [epigenetical], [Drug Therapy], [Pediatric]. Results: 87 articles were found based on titles and abstracts, of which 16 focus on the age group and criteria of interest. Of the 10% of the known etiology, genetic alterations are more important. However, there are epigenetic modifications that are important for leukemia to occur, such as DNA methylation, histone modification, and regulation by non-coding RNAs. Discussion/conclusions: Acute lymphoblastic leukemia in a heterogeneous pathology and the study of its molecular biology is very useful to identify therapeutic targets and have greater effectiveness in treatment and increase disease-free survival with a longer-term than the current one. In each proposed treatment scheme, it is sought that there be greater effectiveness and less toxicity as in the AIEOP-BFM ALL or IDA-FLAG schemes.