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Patients with acute myeloid leukemia (AML) and hyperleukocytosis, defined as an initial white blood cell (WBC) count of ≥ 100 × 109/L, are often treated with leukapheresis. In this study, we have reported our experience of treating AML without leukapheresis. Methods: From November 1, 1995, to May 31, 2012, there were 74 children (≤18 years old) with de novo AML other than acute promyelocytic leukemia. Seventeen patients had an initial WBC count ≥ 100 × 109/L. Prompt chemotherapy was started within hours whereas leukapheresis was not performed. Results: The median age of the 17 patients with hyperleukocytosis was 7.4 years (range: 0–16 years), and the median initial WBC count was 177 × 109/L (range: 117–635 × 109/L). The median time between admission and initiation of chemotherapy was 4.5 hours (range: 2–72 hours) in patients with hyperleukocytosis, whereas it was 13 hours (range: 2–120 hours) in those without hyperleukocytosis. Seven patients (7/17, 41%) had one or more early complications before or during the first 2 weeks of chemotherapy. Fifteen of the 16 patients who received prompt chemotherapy achieved complete remission (93.8%), comparable with those without hyperleukocytosis (98.2%; p = 0.33). Conclusion: Children with AML and hyperleukocytosis, treated with prompt chemotherapy without leukapheresis, had minimal early morbidities.