Acute lymphoblastic leukemia (ALL) is the leading childhood cancer worldwide. Over recent decades, survival from pediatric ALL has risen dramatically in highincome countries due to riskadapted combination chemotherapy, robust supportive care, and coordinated clinical trial networks. However, striking disparities persist between and within regions, particularly in South Asia and Central Asia, where late presentation, treatment abandonment, and limited diagnostic and therapeutic capacity remain major obstacles. This review summarizes the global epidemiology and biology of childhood ALL, outlines treatment outcomes and healthsystem constraints, and examines specific challenges and opportunities in South Asia and Central Asia.