BACKGROUND: Acute lymphoblastic leukemia(ALL) has survival rates of greater than 90% in developed nations. However various sociodemographic factors adversely affect outcome rates in low and middle income countries(LMIC). OBJECTIVE: To study induction outcome of ALL and various factors affecting it. METHODS: This was a prospective cohort study which enrolled 73 children up to age of 18 years with newly diagnosed ALL registered in our newly-established pediatric oncology division over duration of 2.5 years. Sociodemographic and clinical data was collected. Outcome was assessed using morphological remission, minimal residual disease(MRD) and mortality rate. RESULTS: Of the142 children with malignancies registered, 73 were ALL. Mean age was 7.09±4.07 years, male to female ratio 1.15:1. 15(44.12%) had severe acute malnutrition (SAM) and 14(41.17%) had moderate acute malnutrition (MAM). 27(69.23%) children were undernourished. 62(84.93%) were B-ALL, 11(15.07%) T-ALL. 28.77% had WBC counts greater than 50X109/L. t(12;21) was the most common cytogenetic abnormality. 65.76% of the patients belonged to lower socioeconomic status. There were 10 dropouts. 59(93.65%) patients completed induction of which 100% attained morphological remission and 54(91.53%) were MRD negative. There were 4 mortalities, 2(50%) due to sepsis and 2(50%) due to hemophagocytic lymphohistiocytosis(HLH). 41(65.08%) children had morbidities during induction, febrile neutropenia being the commonest. CONCLUSIONS: Successful induction outcome rates at par with high income countries(HIC) can be achieved even in resource-limited settings of LMIC with support from government schemes and NGOs. Decentralized cancer care centres can effectively pave the way in reducing cancer mortality in children of lower socioeconomic status residing in rural areas.