Inotuzumab ozogamicin with low-dose chemotherapy showed efficacy in first-line treatment of older patients with CD22-positive, Philadelphia chromosome–negative B-cell precursor ALL, achieving 73% 1-year overall survival and 66% 1-year relapse-free survival. High-risk cytogenetics and higher MRD2 levels were associated with poorer outcomes, while higher CD22 expression improved survival.