Treatment of childhood hematologic malignancies requires multidisciplinary care and reliable infrastructural support; creating a this structure in resource-poor settings remains challenging. Ideally therapy would be tailored to each region and disease. The development of research initiatives is essential. Acute lymphoblastic leukemia (ALL) and lymphomas are common in low- and middle-income countries; treatment is often resource intense but likely cost effective. Outcomes currently are worse than those reported in high-income countries. Chronic myeloid leukemia can be treated effectively with imatinib. Strategies to decrease the burden of therapy and robust palliative care programs are essential for optimal treatment of all afflicted children.