Objective　To explore the clinical features, diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) with bone changes and hypercalcemia as the first manifestation. Method　The clinical data of childhood B-cell ALL with bone changes and hypercalcemia as the first manifestation were retrospectively analyzed. Results　A boy, aged 6 years and 5 months old, started with abdominal pain. Bone changes and hypercalcemia were found at the initial examination, and ALL was confirmed later. The child was received oral administration of imatinib in addition to CCLG-ALL-2015 chemotherapy, and has been in remission. Conclusion　Hypercalcemia and bone changes can be the first manifestation of B cell ALL