02.15.22

Blinatumomab After Allo-HCT for B-lineage ALL

Gaballa MR, Banerjee PP, Milton DR, et al. Blinatumomab Maintenance After Allogeneic Hematopoietic Cell Transplantation for B-lineage Acute Lymphoblastic Leukemia. Blood. 2022; (doi: 10.1182/blood.2021013290).

Researchers have confirmed the safety and feasibility of administering blinatumomab in patients with B-lineage acute lymphoblastic leukemia (ALL) without relapse following allogeneic hematopoietic cell transplantation (HCT). To reduce the risk of relapse among high-risk ALL patients, blinatumomab was administered in four cycles over three-month intervals in the first year after HCT. The analysis included 21 patients who received at least one cycle of blinatumomab, with a median follow-up time of 78 days. In all, 57% (12) of the patients completed all four cycles. Neutropenia was the only grade 4 complication, while rates of cytokine release (5% G1) and neurotoxicity (5% G2) were low. Grades 2-4 and 3-5 graft-versus-host disease (GVHD) occurred at cumulative rates of 33% and 5%, respectively, with two mild cases and one moderate case of chronic GVHD reported. During a median 14.3 months of follow-up, the one-year overall survival, progression-free survival, and non-relapse mortality rates were 85%, 71%, and 0%, respectively. Blinatumomab's effectiveness did not differ substantially in a matched analysis with a contemporary cohort of 57 patients. Patients with specific T-cell profiles were designated therapeutic "responders" or "non-responders" in corresponding baseline and post-treatment samples. Responders had higher compositions of effector memory CD8 T-cell subsets, while non-responders had fewer T-cells and more inhibitory checkpoint molecules.

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