Abstract
Tyrosine kinase inhibitor (TKI)-combined chemotherapy has become the standard option in pediatric Philadelphia chromosome-positive acute lymphocytic leukemia (Ph+ALL) treatment. Additionally, hematopoietic cell transplantation (HCT) in the first remission is no longer an absolute indication. However, pediatric Ph+ALL remains refractory leukemia, with a disease-free survival rate of approximately 60% for patients without HCT in the first remission due to treatment-related death or relapse after chemotherapy. Further outcome improvement will require an intensified targeted therapy with second- or third-generation TKIs or less toxic immunotherapies, as well as improved safety, with reduced conventional chemotherapy. Continuous attention to these issues in clinical trials will change pediatric Ph+ALL from intractable to manageable leukemia in the future.
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