Chimeric antigen receptor (CAR) T-cell therapy has emerged as a groundbreaking treatment modality in the management of hematologic malignancies, particularly leukemia. By genetically engineering autologous T cells to recognize tumor-associated antigens, CAR T-cell therapy enables precise targeting and potent cytotoxic responses against malignant cells. Clinical trials and real-world studies have demonstrated remarkable remission rates in relapsed and refractory B-cell acute lymphoblastic leukemia (B-ALL), leading to regulatory approvals and the integration of CAR T- cell therapy into clinical practice. Despite these advances, significant challenges remain, including therapy-associated toxicities such as cytokine release syndrome and neurotoxicity, antigen escape, limited persistence of CAR T cells, and barriers to accessibility and scalability. Ongoing research is focused on optimizing CAR design, improving safety profiles, expanding applications to other leukemia subtypes, and developing combination strategies to enhance durability of response. This review provides a comprehensive overview of the current landscape of CAR T-cell therapy in leukemia, highlighting clinical outcomes, mechanistic insights, limitations, and future directions in this rapidly evolving field.