Optimizing outcomes in Philadelphia-positive acute B-cell leukemia: The role of early imatinib introduction in sustaining remission and minimizing relapse risk

Abstract

Philadelphia chromosome-positive acute B-cell leukemia (Ph+ B-ALL) represents a formidable clinical challenge due to its aggressive nature and propensity for relapse. The advent of imatinib, a tyrosine kinase inhibitor targeting the BCR-ABL fusion protein, has reshaped therapeutic paradigms in hematologic malignancies. Despite its established efficacy in chronic myeloid leukemia (CML), the optimal integration of imatinib into frontline therapy for Ph+ B-ALL remains a subject of ongoing investigation. This review synthesizes current evidence to evaluate the impact of early imatinib initiation on achieving sustained complete remission (CR) and mitigating relapse risk in Ph+ B-ALL. We delve into the molecular underpinnings of Ph+ B-ALL, elucidate the rationale for incorporating imatinib upfront, and critically assess clinical studies supporting its use. Furthermore, we explore mechanisms of imatinib resistance, discuss strategies to enhance treatment efficacy, and propose avenues for future research. By providing a nuanced understanding of the role of early imatinib therapy, this review aims to inform therapeutic decision-making and drive improvements in outcomes for patients with Ph+ B-ALL.