Immunotherapy in the up-front treatment of adult B-cell precursor acute lymphoblastic leukemia: when, how, who?

Acute lymphoblastic leukemia (ALL) is a hematologic malignancy characterized by the proliferation of immature lymphoid cells. Despite advances in chemotherapy, a significant proportion of patients continue to have poor outcomes. Immunotherapy has emerged as a transformative approach in the treatment of ALL, offering new hope for these patients. This advances viewpoint article provides a comprehensive overview of the role of immunotherapy in ALL, focusing on the mechanisms of action, the timing of its use, the patient populations most likely to benefit, and drug resistance. We discussed the major immunotherapeutic modalities, including monoclonal antibodies, bispecific T-cell engagers, and chimeric antigen receptor T-cell therapy. We review key clinical trials that have shaped the current landscape of immunotherapy in B-cell precursor (BCP)-ALL, along with future directions in this rapidly evolving field and discussed our perspective on how best to exploit the use of immunotherapy for patients with newly diagnosed adult BCP-ALL.