Immunotherapeutic agents have made remarkable progress in the treatment of acute leukemia. CAR T cell therapy, particularly CD19 and BCMA-targeted CAR-T cells, has shown promising results with high response rates and long remission durations. However, these therapies can be challenging to manage and may present serious toxicities, requiring careful monitoring. Despite the challenges in AML CAR-T cell therapy, new approaches targeting CD33, CD123, and other antigens hold potential for effective treatment options in these patients. In ALL, anti-CD19, anti-CD22 agents, and even CAR-T cell therapies have started to find their place in practical use. With these developments, the integration of immunotherapies into personalized treatment plans is beginning to open new horizons in leukemia treatment.