Olverembatinib: real progress in BCR::ABL1 leukemia?

Olverembatinib (HQP1351) is a potent third-generation (3G) tyrosine kinase inhibitor (TKI) that binds to both the active and inactive conformations of native ABL1 and mutant BCR::ABL1. It was developed as a potent inhibitor with activity against wild-type and mutated BCR::ABL1 for chronic myeloid leukemia (CML) patients. It is effective against the T315I mutation, which confers resistance to first and second generation TKIs. The results of clinical trials in China have led to olverembatinib approval by China's regulatory authority, National Medical Products Administration (NMPA), for adult patients with TKIresistant chronic phase (CP) or accelerated phase (AP) CML harboring the T315I mutation and for adult CP CML patients with resistance or intolerance to imatinib or 2G TKIs. Olverembatinib has also received breakthrough therapy designation by the NMPA in combination with low intensity chemotherapy for the first-line treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Global studies of olverembatinib are underway in CML and Ph +ALL, with the results of the US phase 1b study published in 2025. This review will summarize the safety, tolerability, and efficacy of olverembatinib in CML and Ph+ ALL in China and globally and discuss the role of olverembatinib among existing therapeutics and its future development.