Concurrent application of blinatumomab and haploidentical donor leukocyte infusions for refractory primary
Jasmine Smith1, Abhijeet Kumar2, Natalie A Stanton3
1Department of Pediatrics, University of Arizona, Tucson, AZ, USA.
Insights
A rare lymphoma, primary mediastinal large B-cell lymphoma (PMBCL), achieved remission with haploidentical bone marrow transplant and donor leukocyte infusions plus blinatumomab. This combination shows promise but requires further clinical trial evaluation.
Area of Science:
- Hematology
- Oncology
- Immunotherapy
Background:
- Primary mediastinal large B-cell lymphoma (PMBCL) is a rare, aggressive non-Hodgkin lymphoma.
- Treatment resistance is common, necessitating novel therapeutic strategies.
- Standard therapies, including CAR-T cells, may fail in refractory PMBCL.
Observation:
- A young male patient with refractory PMBCL received haploidentical bone marrow transplantation (haplo-BMT).
- Donor leukocyte infusions (DLIs) were administered concurrently with blinatumomab post-haplo-BMT.
- The patient achieved a complete remission, his first after multiple treatment lines.
Findings:
- This case demonstrates the potential efficacy of combining DLIs with blinatumomab in a haploidentical transplant setting for PMBCL.
- Blinatumomab, typically used for B-cell malignancies, showed activity in PMBCL within this context.
- This represents a novel application of DLIs for PMBCL, as prior reports are absent.
Implications:
- The blinatumomab-DLI combination may offer a new treatment avenue for refractory PMBCL.
- Caution is advised due to potential exacerbation of graft-versus-host disease (GVHD) risks.
- Further investigation in clinical trials is warranted to assess safety and efficacy in high-risk PMBCL patients.
Abstract:
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare hematologic malignancy with distinct clinical and immunopathological features. We report a case of a young male with disease refractory to multiple lines of therapy, including chimeric antigen receptor-T cells, who achieved his first complete remission after haploidentical bone marrow transplantation (haplo-BMT), following donor leukocyte infusions (DLIs) given concurrently with blinatumomab. While DLI has been used after T-replete haplo-BMT with post-transplant cyclophosphamide, there are no reports on its use for PMBCL. Similarly, blinatumomab is active against B-cell lymphomas, but literature is lacking in patients with PMBCL. Our experience illustrates that blinatumomab can be used concurrently with DLI in a haploidentical setting to achieve disease response in PMBCL. Despite our encouraging experience with this case, we would not recommend this approach outside of a clinical trial as blinatumomab may exacerbate the graft versus host disease risks of DLI, especially in a haploidentical setting. Evaluating this treatment combination in high-risk patients in the setting of a clinical trial may be meaningful.
