# Ph-like (BCR::ABL1-like) acute lymphoblastic leukaemia

Source: https://onco.cc/terms/ph-like-all/  
OnCo record `ph-like-all` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Ph-like leukaemia has the gene-expression fingerprint of Philadelphia-positive leukaemia without the Philadelphia chromosome; behind it are dozens of kinase fusions and JAK pathway lesions, and finding which one is present tells doctors whether an imatinib-type drug or a JAK inhibitor might be added to chemotherapy.

## Summary

What is measured: a gene expression signature resembling BCR::ABL1-positive ALL, and then the lesion driving it. How: the signature by low-density array, RNA sequencing or a targeted classifier; the driver by flow cytometry for CRLF2 overexpression and FISH for CRLF2 rearrangement (IGH::CRLF2 or P2RY8::CRLF2, about half of cases, usually with JAK2 or JAK1 mutations), FISH or RNA sequencing for ABL-class fusions (ABL1, ABL2, PDGFRB, CSF1R), JAK2 and EPOR rearrangements, and sequencing for JAK1, JAK2, IL7R and SH2B3 mutations; IKZF1 deletion is common. It accounts for 10 to 15 percent of childhood, 25 to 30 percent of adolescent and young adult and about 20 percent of adult B-ALL, more often in people of Hispanic ancestry, with high residual disease after induction and poor survival on chemotherapy alone. What a positive result changes: ABL-class fusions get dasatinib or imatinib added, as for Ph-positive disease; JAK-STAT lesions are treated with ruxolitinib in trials (COG AALL1521); everyone is treated on high-risk arms with residual disease measured closely, and blinatumomab, inotuzumab or CAR-T are used for persistent disease with transplant considered in first remission. Where it matters: the Ph-like ALL page, adult ALL and high-risk childhood ALL.

## Fields

- Kind: Term
- Last checked: 2026-09-17
- Also known as: Ph-like; Ph-like ALL; BCR::ABL1-like ALL; BCR-ABL1-like; Philadelphia chromosome-like ALL; Ph-like signature; Ph-like gene expression signature; CRLF2 rearrangement; CRLF2-rearranged; CRLF2 overexpression; ABL-class fusion; ABL-class fusions; JAK-STAT class ALL; EPOR rearrangement

## Connected records

- terms: [B-ALL risk groups (NCI criteria, ETV6::RUNX1, hyperdiploidy, hypodiploidy, iAMP21, IKZF1, CNS status)](https://onco.cc/terms/b-all-cytogenetic-risk/), [FISH / ISH (in situ hybridisation)](https://onco.cc/terms/fish/), [Flow cytometry (immunophenotyping)](https://onco.cc/terms/flow-cytometry/), [Minimal / molecular residual disease (MRD)](https://onco.cc/terms/mrd/), [Philadelphia chromosome (Ph+, BCR::ABL1)](https://onco.cc/terms/philadelphia-chromosome/)
- drugs: [Blinatumomab](https://onco.cc/drugs/blinatumomab/), [Dasatinib](https://onco.cc/drugs/dasatinib/), [Imatinib](https://onco.cc/drugs/imatinib/), [Ruxolitinib](https://onco.cc/drugs/ruxolitinib/)
- technologies: [RNA sequencing & expression profiling](https://onco.cc/technologies/rna-seq/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL)](https://onco.cc/cancers/all-ph-like/)

---
JSON: https://onco.cc/api/v1/entities/ph-like-all.json