Ph+ ALL in 2022: is there an optimal approach?

Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) carried a very poor prognosis prior to the advent of tyro sine kinase inhib i tors (TKIs) that block the activ ity of the BCR - ABL1 oncoprotein. With improve ments in TKI effi cacy and allo ge neic hema to poi etic cell trans plan ta tion (HCT), sur vival has improved over the past 3 decades, and the role of chemotherapy and allogeneic HCT is now changing. Better risk stratification, the application of the third-generation TKI ponatinib, and the use of immu no ther apy with the CD19 - CD3 bifunc tional T -cell engag ing anti body blinatumomab in place of che mo ther apy has made ther apy for Ph + ALL more tol er a ble and argu ably more effi ca cious, espe cially for older patients who com prise most patients with Ph + ALL.