{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:10:01Z","timestamp":1788174601664,"version":"build-2803163510"},"reference-count":21,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Haematol"],"abstract":"<jats:p>Introduction: Measurable residual disease (MRD) assessment in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) commonly relies on reverse transcription polymerase chain reaction detection of BCR::ABL1 transcripts. However, discordance between BCR::ABL1 PCR and next-generation sequencing (NGS)-based MRD assays targeting immunoglobulin\/T-cell receptor (IG\/TR) rearrangements may occur, particularly in cases of multilineage Ph+ ALL, complicating treatment decisions such as tyrosine kinase inhibitor (TKI) discontinuation. Case Presentation: We report a 54-year-old female with Ph+ ALL who achieved durable remission with sustained NGS MRD negativity by IG\/TR despite persistent low-level BCR::ABL1 transcript positivity. Following self-discontinuation of ponatinib, she experienced a rapid rise in BCR::ABL1 transcripts and loss of cytogenetic remission in myeloid cells, while remaining morphologically in remission and NGS MRD-negative. Reintroduction of ponatinib resulted in a prompt transcript decline. Conclusion: This case highlights the clinical significance of multilineage Ph+ ALL and its distinct biological background, thereby underscoring caution with TKI discontinuation despite deep NGS MRD negativity and may support continued TKI therapy in this setting.<\/jats:p>","DOI":"10.1159\/000551699","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T16:00:49Z","timestamp":1774972849000},"page":"1-6","source":"Crossref","is-referenced-by-count":4,"title":["A Case Report of Tyrosine Kinase Inhibitor Interruption in a Patient with Multilineage Philadelphia-Positive Acute Lymphoblastic Leukemia"],"prefix":"10.1159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1945-2571","authenticated-orcid":false,"given":"Hannah","family":"Goulart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Braish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Short","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagop","family":"Kantarjian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias J.","family":"Jabbour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-707562"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01668-0"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26949"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2022007378"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-09-806521"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021006727"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1158\/2643-3230.BCD-21-0095"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2017.176917"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-11-749978"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26816"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-11-466482"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25338"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-08-798322"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2022-157442"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.24.00108"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2024.286325"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35773"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2016272"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01075"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(22)00319-2"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17152457"}],"container-title":["Acta Haematologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000551699","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T16:00:52Z","timestamp":1781020852000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000551699"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":21,"URL":"https:\/\/doi.org\/10.1159\/000551699","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.31898173","asserted-by":"subject"}]},"ISSN":["0001-5792","1421-9662"],"issn-type":[{"value":"0001-5792","type":"print"},{"value":"1421-9662","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}