Philadelphia-like acute lymphoblastic leukemia: diagnostic dilemma and management perspectives

•Philadelphia (Ph)-like acute lymphoblastic leukemia (ALL) is a new subgroup of ALL.•Ph-like ALL is characterized by high cytokine receptor and tyrosine kinase signaling.•Accurate and standard testing approaches are not widely available.•With the currently available therapies, the outcomes of Ph-like ALL are suboptimal.•Targeting the affected pathways might alter the prognosis of this new subgroup. Acute lymphoblastic leukemia (ALL) is an aggressive hematologic malignancy characterized by suboptimal outcomes in the adult age group. Recently, a new subtype called Philadelphia (Ph)-like ALL has been described. This subgroup is characterized by high cytokine receptor and tyrosine kinase signaling expression, resulting in kinase activation through stimulation of two main pathways, the ABL and JAK/STAT pathways. The diagnostic method or approach for Ph-like ALL is still not standardized and efforts are ongoing to identify an easy and applicable diagnostic method. Accurate and standard testing approaches are much needed and this will facilitate better understanding of this subgroup, including better estimation of the prevalence and incidence in different age groups and the clinical outcomes of such new entity. Here, we review the currently available diagnostic tools, activated pathways, and different therapeutic approaches used to target this subgroup.