Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) is a rare, high-risk, aggressive form of acute leukemia, affecting primarily adults and the elderly. Patients with high-risk forms of ALL typically have extremely poor prognosis and incur high disease-related costs. Successful use of imatinib in patients with Ph+ chronic myelogenous leukemia (CML) has led to the administration of imatinib in recent clinical studies for patients with Ph+ALL. In this review, the clinical outcomes of imatinib used as a single-agent or in combination with chemotherapy are discussed. In addition, an overview of the economic and quality of life burden associated with high-risk forms of ALL (with Ph+ALL being the most common high risk ALL), as well as the cost-effectiveness of imatinib in Ph+ALL compared with conventional chemotherapy, are presented.