How would you approach a patient with relapsed Ph+ ALL and MRD positive after blinatumomab?

There is currently no defined standard-of-care treatment for pediatric relapsed Ph+ ALL. Nevertheless, many patients with relapsed Ph+ ALL can be successfully salvaged in the TKI era (especially those who had not undergone HSCT in CR1) since the 5-year EFS of pediatric Ph+ ALL on the recently published AALL1122 trial was 55% while the 5-year OS exceeds 80% (Hunger et al., PMID 37407142). Thus, in the relapsed Ph+ ALL setting, the general approach would aim to achieve MRD-negative CR2 through rei...