A 54-year-old male had BCR::ABL1 p190, TP53, IKZF1-mutated acute lymphoblastic leukemia with extramedullary disease of the clivus and ribs. He received alkylating chemotherapy and ponatinib, followed by blinatumomab and ponatinib, achieving complete remission but with minimal residual disease. He then attained complete molecular remission after undergoing myeloablative haploidentical-related stem cell transplantation conditioned with cyclophosphamide and total body irradiation with posttransplant cyclophosphamide, mycophenolate mofetil, and tacrolimus graft-versus-host disease prophylaxis. On day 60 post-transplant, he began a daily maintenance dose of 15 mg of ponatinib.