Acute lymphoblastic leukemia (ALL) is the major causes of death in children. In Malaysia, leukemia is the commonest cancer in children and the sixth most frequent cancer. Acquired chromosomal abnormalities are the hallmark of ALL, which define biologically distinct subtypes of the disease. The strong association of many chromosomal abnormalities with prognosis has been utilised in risk stratification for treatment in a large number of protocols worldwide. Here, I will discuss genetic characterization of the Malaysian BCP-ALL cohort to enable risk stratification model development. Further, we provide an overview about the ALL treatment protocols and review the strategies that would improve the treatment outcome of ALL patients through integration of genetic characterisation and the clinical data.