Blinatumomab for MRD-Negative Acute Lymphoblastic Leukemia in Adults
Mark R Litzow1, Zhuoxin Sun1, Ryan J Mattison1
1From the Mayo Clinic, Rochester, MN (M.R.L., C.L.W., M.A.E.); Dana-Farber Cancer Institute, Boston (Z.S., D.J.D., R.M.S.); the University of Wisconsin Carbone Cancer Center, Madison (R.J.M.), and the Medical College of Wisconsin, Milwaukee (E.L.A.); Montefiore Medical Center Moses Campus (E.M.P., J.R.) and Memorial Sloan Kettering Cancer Center (Y. Zhang, M.S.T.) - both in New York; the Department of Pathology and the Center for Excellence for Leukemia Studies (K.G.R., Y. Zhao, C.G.M.) and the Center for Applied Bioinformatics (G.W., T.-C.C., W.Z.), St. Jude's Children's Research Hospital, Memphis, TN; Case Western Reserve University (H.M.L.) and Cleveland Clinic Foundation (A.S.A.), Cleveland, and the Ohio State University Comprehensive Cancer Center, Columbus (B.B.) - all in Ohio; Shaare Zedek Medical Center, Jerusalem, Israel (J.M.R.); Stanford Cancer Institute, Palo Alto (D.A.A., M.L.), the University of California, San Diego, Moores Cancer Center, La Jolla (M.J.W., D.T.), and the University of California, Irvine, Health Cancer Center-Newport, Orange (D.J.) - all in California; the University of Chicago (D.A.A.) and Northwestern University (S.N.D.) - both in Chicago; Hopital Maisonneuve-Rosemont, Montreal (J.B.); the University of Washington, Seattle (B.L.W.); Johns Hopkins University Sidney Kimmel Cancer Center, Baltimore (K.W.P.), and the National Cancer Institute, National Institutes of Health, Bethesda (E.S., R.F.L.) - both in Maryland; the University of Pennsylvania Abramson Cancer Center, Philadelphia (N.F., S.M.L.); Yale School of Medicine, New Haven, CT (S.D.G.); the Washington University in St. Louis School of Medicine, St. Louis (G.L.U.); the University of Kansas Cancer Center, Westwood (T.L.L.); Virginia Commonwealth University Massey Cancer Center, Richmond (S.B.P.); the University of Alabama at Birmingham, Birmingham (P.V.); and Wake Forest University Health Sciences, Winston-Salem (R.R.B.), and Duke University Medical Center, Durham (H.P.E.) - both in North Carolina.
Adding blinatumomab to chemotherapy significantly improved overall survival for adults with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) in remission. This treatment offers a better chance of long-term survival for these patients.
Area of Science:
- Hematology
- Oncology
- Immunotherapy
Background:
- Older adults with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) often relapse even after achieving measurable residual disease (MRD)-negative remission with chemotherapy.
- Blinatumomab, a bispecific T-cell engager, is approved for relapsed/refractory BCP-ALL and may benefit patients in MRD-negative remission.
Purpose of the Study:
- To evaluate the efficacy of adding blinatumomab to consolidation chemotherapy in adult patients with MRD-negative BCP-ALL.
- To compare overall survival (OS) and relapse-free survival (RFS) between blinatumomab plus chemotherapy and chemotherapy alone.
Main Methods:
- A Phase 3 trial randomized 30-70 year olds with BCR::ABL1-negative BCP-ALL in MRD-negative remission (<0.01% leukemic cells) to receive blinatumomab plus consolidation chemotherapy or consolidation chemotherapy alone.
- The primary endpoint was overall survival; relapse-free survival was a secondary endpoint.
Main Results:
- At a median follow-up of 43 months, the blinatumomab group showed significantly improved overall survival (3-year OS: 85% vs. 68%; HR 0.41, P=0.002).
- Three-year relapse-free survival was higher in the blinatumomab group (80% vs. 64%; HR 0.53).
- Neuropsychiatric events were more frequent in the blinatumomab arm.
Conclusions:
- Adding blinatumomab to consolidation chemotherapy significantly improves overall survival in adult patients with MRD-negative BCP-ALL.
- Blinatumomab represents a valuable therapeutic option for maintaining remission in BCP-ALL.
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