A 32-year-old woman is diagnosed with Philadelphia chromosome-positive ALL (Ph+ ALL). Current treatment guidelines recommend adding which tyrosine kinase inhibitor to the chemotherapy backbone to improve outcomes?

• A Imatinib alone without chemotherapy
• B Venetoclax plus rituximab
• C Blinatumomab without TKI
• D Dasatinib (second-generation BCR-ABL inhibitor) ✓

Explanation

Ph+ ALL (BCR-ABL1 positive) constitutes 25–30% of adult ALL. Current standard of care is chemotherapy + TKI. Dasatinib is preferred over imatinib due to superior CNS penetration and activity against T315I mutation. Blinatumomab (anti-CD19/CD3 BiTE) is used for MRD-positive or relapsed B-ALL but does not replace TKI in Ph+ ALL. Venetoclax + rituximab is used in CLL, not ALL. Imatinib alone is insufficient for induction.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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