Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) accounts for approximately 25% of all adult B-precursor ALL cases. This condition is characterized by a reciprocal t(9;22) translocation that generates BCR–ABL, a chimeric fusion protein, with constitutively upregulated tyrosine kinase activity. The presence of the Ph chromosome has been associated with an extremely poor prognosis [
1]. However, the response to treatment and survival outcomes have improved significantly over the last decade [
2‐
4]. The combination of BCR–ABL tyrosine kinase inhibitors (TKIs) and chemotherapy has substantially improved the outcome of patients with Ph+ ALL [
2‐
4]. Although combination chemotherapy with imatinib or dasatinib is effective, the 3-year event-free survival and overall survival rates for adult patients with Ph+ ALL are approximately 40% and 60%, respectively [
2,
3]. In developing a novel therapeutic strategy for patients with Ph+ ALL, the acquisition of TKI resistance induced by point mutations within the BCR–ABL kinase domain (KD) should be addressed [
5]. The T315I mutation, which is highly resistant to imatinib and second-generation TKIs, is a major cause of recurrence in patients with Ph+ ALL [
5]. Ponatinib, a third-generation TKI, is a potent BCR–ABL inhibitor in leukemia patients with both wild-type and BCR–ABL mutations, including T315I [
6]. However, a T315I-positive clone acquires an additional resistance mutation, resulting in high resistance even to ponatinib. Therefore, a new treatment strategy for eliminating such clones with double or triple compound mutations should be developed [
7]. Blinatumomab (BLIN) is a bispecific T-cell engager antibody construct that directs cytotoxic T cells to CD19-expressing B cells [
8‐
10]. BLIN has single-agent activity in patients with B-ALL with minimal residual disease (MRD) during the first complete remission (CR) or thereafter and in those with relapsed/refractory (R/R) B-ALL, including R/R Ph+ ALL [
8,
9]. BLIN monotherapy has therapeutic effects on immunological outcomes regardless of the BCR–ABL status, even with the presence of the T315I mutation. Moreover, patients with Ph+ ALL who receive this treatment achieve hematological or molecular remission [
8]. This result indicates that BLIN can eliminate highly TKI-resistant leukemic clones with double or triple compound mutations. A few studies have shown that TKI + BLIN combination therapy is safe and effective [
11,
12]. This combination therapy is considered an extremely reasonable therapeutic strategy due to its mechanism of action. Herein, we report two patients with TKI-resistant R/R Ph+ ALL who achieved molecular remission after receiving BLIN + ponatinib combination therapy.