The Role of Imatinib in Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia

Incorporation of imatinib, a BCR-ABL tyrosine kinase inhibitor, into treatment regimens for Philadelphia-chromosome positive acute lymphoblastic leukemia (ALL) has improved outcomes. Single agent therapy, as well as imatinib in combination with chemotherapy demonstrates high response rates, however durable remissions are rare due to rapid development of resistant disease. The only potentially curative option is stem cell transplant, which remains the recommendation for eligible patients in first complete remission. Significant challenge lies in recognizing and overcoming kinase domain mutations. Second generation tyrosine kinase inhibitors can overcome a majority of imatinib resistant mutations and inclusion of these agents will be integrated into future treatment regimens.