Background: Acute lymphoblastic leukemia (ALL) in infants is known to be biologically different from ALL in older children. Aim: We aimed to determine the clinical and laboratory characteristics, outcomes, and toxicities of infants with ALL treated with interfant-99 and St. Jude Total Therapy XV protocols at the National Cancer Institute (NCI), Egypt. Methods: This retrospective study included infants diagnosed with ALL between January 2010 and December 2019. Results: Of the total 40 cases, 25 (62.5%) were males, and 15 (37.5%) were females. Age at examination was < six months in 14 (35%) and ≥ six months in 26 (65%) cases. The total leukocyte count (TLC) at examination was >250 x103 in 11 (27.5%) cases. KMT2A rearrangement was done for 24 (60%) patients; it was wild-type in 5 (20%) and rearranged in 19 (80%) cases. 24 (60%) patients received Interfant-99, 14 (35%) received St. Jude total XV therapy, and 2 (5%) died on day 1. Relapse occurred in 10 (25%) patients. There was no difference in overall survival (OS) or event-free survival (EFS) between those treated with Interfant-99 versus St. Jude total XV therapy. The three-year OS was 26.3% for the whole group, and the three-year EFS was 14%. Conclusions: The patients had lower survival rates than those in the comparable studies in developed countries but are comparable to those in developing countries. Infection and sepsis, the leading causes of death, account for 78% of deaths, highlighting the importance of supportive care for such vulnerable patients.