Objective To understand the current status of return to school in children with hematological malignancies and analyze its influencing factors based on Meleis′ Transition Theory. Methods A cross-sectional survey was conducted on 226 children (8-18 years old) with hematological malignancies who attended the hematological oncology ward and outpatient department of a Grade A tertiary hospital in Guangzhou from August 2023 to October 2024. Potential influencing factors were identified per transition conditions in Meleis′ Transition Theory. Surveys were performed using a self-designed general information questionnaire, Pediatric quality of life inventory TM 3.0 cancer module (PedsQLTM 3.0), Brief Illness Perception Questionnaire (BIPQ), and Multidimensional Scale of Perceived Social Support (MSPSS). Results Only 41.1% of the 226 children returned to school, with a median school suspension duration of 12 (11, 19) months. Among the returnees, 68.8% repeated a grade. Binary logistic regression analysis showed that treatment phase, disease risk, illness perception, and teacher support and family support (from MSPSS) were significant influencing factors for school return in children with hematological malignancies (all P<0.05). Conclusion The return to school in children with hematological malignancies needs improvement, characterized by late return and high grade repetition rate. It is suggested to strengthen hospital-school cooperation, establish a multi-disciplinary full-course health management model for school return, and develop personalized hospital-school transition interventions to promote their return to school.