Background: Acute lymphoblastic leukemia (ALL) is a heterogeneous hematological disease, constituting 75-80% of leukemia in children. L-asparaginase is a key component of the standard induction therapy for pediatric ALL. The present study aimed to evaluate the clinical profile of pegylated Escherichia coli asparaginase (pegaspargase) in terms of treatment-related side effects in pediatric patients with ALL. Methods: This retrospective study included pediatric patients with ALL who were treated at the Pediatric Hemato-Oncology Center in Hyderabad from Jan 2019 to Dec 2022. The medical records of patients aged 18 years and below, with a diagnosis and treatment for ALL, were accessed. Patients treated with intramuscular/intravenous pegaspargase (2,500 IU/m2) for ALL were included in the study. Patient demographic characteristics and disease status were documented. The adverse events with the use of pegaspargase were also noted. Results: A total of 300 patients with ALL were included in the study. The majority of patients were aged <10 years (65.7%). Most of the patients were male (58%). B-cell ALL was the predominant immunophenotype in 253 patients. As per the National Cancer Institute (NCI) criteria, 192 patients had standard-risk ALL. Bacterial/fungal infection was the most common manifestation in 25.7% of patients. Allergic reactions were observed in 15% of patients. Thrombosis was noted in 19 patients, while 18 patients experienced fatigue. Other side effects included hypertension (n=13), hyperglycemia (n=11), and pancreatitis (n=8). Conclusion: Pegaspargase holds promise as a vital therapeutic agent in the treatment of pediatric ALL, with most adverse events being manageable and reversible.