Philadelphia-like chromosome acute lymphoblastic leukemia (Ph-like ALL) is a new subtype of B-ALL that was discovered in 2009 and recognized in the 2016 revision of the World Health Organization criteria under the classification of myeloid neoplasms and acute leukemia. This new subtype has an extremely poor prognosis compared to that for other subtypes of ALL, with a 41% five-year overall survival (OS) rate. Ph-like ALL is chemoresistant, with a high minimum residual disease (MRD) level after induction therapy, and it is associated with a high relapse rate. Clinical trials are currently being conducted to study the effectiveness of specific tyrosine kinase inhibitors against different genetic alterations in Ph-like ALL patients and the effect of allogeneic hematopoietic cell transplants (allo-HCT) on treatments. This review summarizes the current findings on Ph-like ALL, focusing on its molecular landscape and clinical implications.