Management of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

The successful incorporation of tyrosine kinase inhibitors (TKIs) to chemotherapy regimens in patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) has significantly improved the outcome of these patients. This advancement has also generated several new areas of investigation such as identifying the role of reduced or chemotherapy-free induction therapy, the best TKI option, the benefit of allogeneic hematopoietic stem cell transplant (HSCT) in first remission, and the effect of prophylactic TKI post-HSCT in patients with Ph-positive ALL. Novel treatment modalities such as bispecific T-cell engagers (e.g., blinatumomab), drug conjugate monoclonal antibodies (e.g., inotuzumab ozogamicin), more potent TKIs, and chimeric antigen receptor T-cell therapies are being investigated. In this chapter, we will provide an overview of the current and future treatment paradigms for Ph-positive ALL.