Philadelphia chromosome positive acute lymphoblastic leukemia in adults: Therapeutic options and dilemmas in 2020

The incorporation of tyrosine kinase inhibitors (TKI) into front-line therapy for adults with Philadelphia chromosome positive acute lymphoblastic leukemia has dramatically altered response rates and significantly improved outcomes, such that this entity may no longer be considered a high risk acute lymphoblastic leukemia subgroup. In this review article, we summarize approaches to front-line therapy in the TKI era, including intensive chemotherapy-based regimens and deintensified therapy. We also review optimal disease monitoring strategies, discuss the role of consolidative hematopoietic cell transplantation, and touch on options for relapsed disease. The incorporation of novel targeted agents in conjunction with TKIs into front-line therapy will likely alter the future therapeutic approaches to this disease.