Leukemia is a hematologic malignancy characterized by abnormal proliferation of leukocytes. Hematological and clinical profiles may influence leukemia outcomes; however, information regarding their association with outcomes in pediatric leukemia patients in West Nusa Tenggara Province remains limited. To determine the association between hematological and clinical profiles and leukemia outcomes in children at the Regional General Hospital of West Nusa Tenggara Province. This quantitative observational analytic study used a cross-sectional design involving pediatric leukemia patients aged 0–18 years diagnosed between April 2024 and October 2025. Patients were selected using total sampling from medical records. Hematological variables included erythropenia, thrombocytopenia, leukocyte count, and anemia, while clinical variables included fever, bleeding, pallor, hepatomegaly, lymphadenopathy, splenomegaly, and bone or joint pain. Of 65 eligible patients, 51 were included; 52.9% had acute lymphoblastic leukemia, 29.4% acute myeloid leukemia, and 17.6% chronic myeloid leukemia. Thirty-eight patients (74.5%) received chemotherapy. The most common findings were erythropenia (80%), thrombocytopenia (82.3%), anemia (82.3%), pallor (68.6%), and splenomegaly (66.7%). In the therapy group, thrombocytopenia (p = 0.016), bleeding (p = 0.037), and bone or joint pain (p = 0.038) were significantly associated with outcomes. In the non-therapy group, only bone or joint pain was significantly associated with outcomes (p = 0.029). Thrombocytopenia, bleeding, and bone or joint pain were associated with outcomes among patients receiving therapy, while bone or joint pain was associated with outcomes among non-therapy patients.