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Abstract Matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) regulate the turnover of the extracellular matrix and modulate the biology of hematopoietic cell. MMP-2.-9 & TIMP-1 play a fundamental role in tumor invasion and metastasis. This study aimed to finding a correlation between the expression of these markers and extramedullary involvement as well as in pediatric acute lymphoblastic leukemia (ALL).Results revealed a statistically significant difference in TLC among MMP9 & TIMP1 positive cases. Hepatomegaly showed statistically significant higher incidence among MMP9 positive cases and CD34 expression showed a statistically significant higher incidence in MMP2 positive group |