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Low SOS/VOD Risk with Inotuzumab Ozogamicin as a Bridging Strategy to Second Allogeneic HSCT: A Real-World Study in
Transplantation and Cellular Therapy
|May 22, 2026
Summary
Inotuzumab ozogamicin (InO) effectively controls relapsed B-cell acute lymphoblastic leukemia (B-ALL) post-transplant, enabling a safe bridge to a second transplant without causing sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD). This strategy improves survival outcomes for patients with B-ALL.
Area of Science:
- Hematology
- Oncology
- Transplantation Medicine
Background:
- Relapse of B-cell acute lymphoblastic leukemia (B-ALL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a significant clinical challenge.
- Inotuzumab ozogamicin (InO) is considered for bridging to a second allo-HSCT, but concerns about sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) limit its use.
Purpose of the Study:
- To assess the risk of SOS/VOD and the safety of InO as a bridging strategy to second allo-HSCT in patients with relapsed or persistent MRD-positive B-ALL.
- To evaluate response rates, survival, and transplant outcomes in patients treated with InO.
Main Methods:
- Retrospective analysis of 25 patients with post-allo-HSCT relapsed or persistent MRD-positive B-ALL treated with InO.
- Evaluation of SOS/VOD incidence, hepatic safety, response (CR, MRD negativity), and transplant outcomes (engraftment, GVHD, survival, relapse).
Main Results:
- No cases of SOS/VOD were observed. Most patients maintained normal bilirubin levels, with transient, manageable AST/ALT elevations.
- High response rates: 76.9% CR in morphologic relapse, 91.6% MRD negativity conversion in MRD-positive patients.
- Nine patients proceeded to second allo-HSCT; those bridged showed trends toward improved OS and LFS, with a lower cumulative incidence of relapse compared to non-bridged patients.
Conclusions:
- Inotuzumab ozogamicin can safely bridge patients with relapsed B-ALL to a second allo-HSCT, with an unexpectedly absent incidence of SOS/VOD.
- Optimized dosing and conditioning strategies may mitigate InO's hepatotoxic risks, facilitating access to potentially curative transplantation.
- InO demonstrates clinical value in disease control and enabling transplantation for refractory B-ALL.
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