Abstract We assessed the epidemiologic progress against childhood and adolescent acute lymphoblastic leukaemia (ALL) in the Netherlands over a 26 year period. ALL patients <18 years were selected from the Netherlands Cancer Registry and the Dutch Childhood Oncology Group. Trend analyses were performed over time and by age group and ALL subtype. Between 1990 and 2015, 2997 ALL patients were diagnosed, i.e. 115 patients (range 87–147) per year. Overall incidence remained stable at 37 per million children, despite increases for B-cell precursor ALL (BCP-ALL) at age 10–14 years (AAPC + 1.4%, p = 0.04) and T-cell ALL at 15–17 years (AAPC + 3.7%, p = 0.01). Five-year survival increased from 80% in 1990–94 to 91% in 2010–15 ( p < 0.01). Mortality decreased by 4% annually ( p < 0.01). Patients 15–17 years were increasingly treated in a paediatric oncology centre, from 35% in 1990–94 to 87% in 2010–15 and experienced a 70% reduction of risk of death compared to those treated outside such a centre ( p < 0.01). Significant progress against childhood ALL has been made in the Netherlands, visible by improved survival rates coinciding with declining mortality rates. These outcomes were accompanied by stable incidence rates, despite increases for BCP-ALL at age 10–14 years and T-cell ALL at age 15–17 years.