Introduction: The objective of this study is to determine the major causes of early death in acute lymphoblastic leukemia (ALL). 
Methods: The following databases including PubMed, EMBASE, Science Direct and Google Scholar were searched for following terms: “acute lymphoblastic leukemia”, “early mortality”, “early death “ and “death in induction phase “. Inclusion criteria were all studies about the etiologies of early mortality in children with acute lymphoblastic leukemia. Early death means death occurs within 30 days of starting induction chemotherapy.
Results: In total, 12 studies fulfilled inclusion criteria.7561 children under 18 years of age were studied in this review. Of these, 354 patients died during the induction phase of therapy. The early mortality rate was 4.6%±4.8. The most common cause of early death was an infection (52.5%), which was mainly bacterial. The second leading cause was bleeding (15%), and tumor lysis syndrome (4%) was the third most common cause. The other causes were septic shock (2%), hyperleukocytosis (2%), encephalopathy (1.7%), cardiomyopathy (1.7%), chemotherapy-related toxicity (1.2%), and thrombotic events (0.6%).
Conclusion: It is needed to advance supportive care to prevent infection by starting Intravenous immunoglobulin for infant and prophylaxis against Pneumocystis jiroveci with trimethoprim/sulfamethoxazole in neutropenic patients during induction, and bleeding by transfusion support.