Table 2.

Evolving therapeutic strategies in adult Ph+ ALL

Increasing age and comorbidityMRD negative stateAvailable donorIncreased TKI efficacy
Chemotherapy ↓ ↓ ↓ ↓ 
AlloHCT ↓ ↓ ↑ ↓ 
AutoHCT ↑ ↑ ↑ 
TKIs ↑ ↑ ↑ ↑ 
Novel therapies (antibodies, chimeric antigen receptor T-cells) ↑ ↑ 
Increasing age and comorbidityMRD negative stateAvailable donorIncreased TKI efficacy
Chemotherapy ↓ ↓ ↓ ↓ 
AlloHCT ↓ ↓ ↑ ↓ 
AutoHCT ↑ ↑ ↑ 
TKIs ↑ ↑ ↑ ↑ 
Novel therapies (antibodies, chimeric antigen receptor T-cells) ↑ ↑ 

Traditional treatment of younger patients with Ph+ ALL with an available donor involved limited initial chemotherapy followed by alloHCT. With introduction of potent TKIs and particularly in older and more infirm patients, the role of chemotherapy and alloHCT has decreased. Several studies have confirmed the prognostic benefit of achieving CMR early in the course of therapy. With introduction of more potent TKIs and novel agents such as the bispecific antibody blinatumomab we may witness further reduction in the intensity of chemotherapy and elucidation of the role of alloHCT in this disease. The direction of arrows indicates the degree of reliance on the available modalities of therapy. “?” indicates lack of adequate data related to the interaction.

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