The effects of blinatumomab therapy in patients with relapsed/refractory acute lymphoblastic leukemia before transplantation

The study investigated whether blinatumomab (Blincyto) can be used for salvage therapy before hematopoietic cell transplantation (HCT) in patients with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (B-ALL). The main finding was that blinatumomab can be safely and effectively used in patients with r/r B-ALL before HCT.

Relapsed ALL refers to leukemia’s return after initial treatment. Refractory means that leukemia is unresponsive to any standard treatment. Salvage therapy is given to such patients with (r/r) ALL. Blinatumomab showed significant progress in treating these patients. Blinatumomab is an immunotherapy. It works by activating the T cells of the immune system to attack and kill cancer cells.

Patients who respond to salvage therapy commonly receive HCT for improving long-term survival. However, the outcomes of HCT in patients who received blinatumomab salvage are still unknown.

A total of 89 adult patients with r/r B-ALL received salvage treatment with blinatumomab. Each of them was given 1.8 cycles of blinatumomab on average. Patients who responded to salvage treatment went on to have HCT. Patients were followed-up for 18 months on average.

43 patients (48%) achieved remission. Overall, 77% of patients were alive 1 year after the HCT. 52% of patients were alive 2 years after HCT. Percentages of patients who survived without leukemia were 65% at 1 year and 40% after 2 years of HCT. Relapse was observed in 18% of patients after 1 year and in 36% of patients after 2 years of HCT.

Graft vs host disease (GVHD) is a condition where the transplanted hematopoietic cells attack a patient’s body. 36% of patients experienced long-term GVHD after 2 years. 13 patients had inflammatory responses to blinatumomab but they responded well to supportive treatments. None of them required to stop taking blinatumomab.

The authors concluded that blinatumomab salvage therapy is an effective and safe treatment in patients with r/r B-ALL prior to HCT. 

This study looked back in time to analyze patients’ data from one hospital only. Additional studies on a larger number of patients can be performed over multiple centers for stronger evidence.