LATEST ADVANCES IN THE TREATMENT OF ACUTE LYMPHOBLASTIC LEUKEMIA: A NARRATIVE REVIEW OF NOVEL TARGETED AND IMMUNOTHERAPEUTIC STRATEGIES

Abstract

Objectives: Acute lymphoblastic leukemia (ALL) treatment is changing rapidly as immunotherapy, targeted drugs, and measurable residual disease (MRD) testing move into routine care. This review summarizes major therapeutic advances reported between 2019 and 2026. Methods: This SANRA-informed narrative review synthesized peer-reviewed clinical studies, major guidelines and consensus recommendations, and regulatory sources, emphasizing evidence from January 2019 through 15 August 2026 with selective earlier landmark studies. Evidence was summarized descriptively; no formal systematic-review screening, risk-of-bias assessment, GRADE evaluation, or meta-analysis was performed. Results: In ECOG-ACRIN E1910, adding blinatumomab to consolidation chemotherapy improved 3-year overall survival in adults with MRD-negative remission from 68% to 85% [33]. Preliminary conference-reported phase III GIMEMA ALL2820 results favored ponatinib plus blinatumomab over imatinib plus chemotherapy for complete hematologic remission, day-133 MRD response, and 18-month event-free survival in newly diagnosed Ph+ ALL [69]. CD19-directed CAR T-cell therapies produce high remission rates in R/R B-cell precursor ALL [35, 43, 46], while revumenib provides a targeted option for R/R KMT2A-translocated acute leukemia [22, 56]. MRD increasingly informs risk-adapted treatment decisions [66]. Conclusions: ALL treatment is becoming more personalized and increasingly guided by immunotherapy, molecular targets, and MRD, although resistance, immune toxicity, transplantation decisions, cost, and unequal access remain important barriers.