Blinatumomab for unresponsive aggressive non-Hodgkin lymphoma

This study looked at using both chemotherapy and blinatumomab (Blincyto) prior to stem cell transplant (SCT) for patients with relapsed or unresponsive aggressive non-Hodgkin lymphoma (NHL). It found that blinatumomab is an effective second salvage for patients who did not fully respond to chemotherapy.

NHL is a group of cancers that affect white blood cells in the lymph nodes. B-cell NHL affects a type of white blood cell known as B-cells. The most common form of B-cell NHL is diffuse large B-cell lymphoma (DLBCL), which is a fast-growing cancer.

SCT is an option for fast-growing NHL which has returned after previous treatment. SCT involves isolating stem cells (which can become any type of blood cell) from the blood or bone marrow. Then, chemotherapy is used to kill off the body’s B-cells, including the harmful NHL. Finally, the healthy stem cells are transfused back into the body where they become cancer-free B cells. For SCT to be effective, it is essential that chemotherapy remove as much of the NHL as possible. However, only 30 to 40% of patients with relapsed B-cell NHL respond to chemotherapy. If a cancer does not completely respond to first-line therapy, salvage (rescue) therapy can be given.

Blinatumomab is an antibody therapy that can direct T-cell white blood cells to kill B-cells. Blinatumomab is a treatment for the blood cancer B-cell acute lymphoblastic leukemia. A small Phase I study found that blinatumomab may also be effective for patients with aggressive NHL. The effectiveness and safety of blinatumomab in patients with aggressive NHL who did not respond to chemotherapy are still unknown. 

This study included 41 patients with relapsed B-cell NHL. 68% of patients did not respond to initial treatment. All patients planned treatment with SCT but had not fully responded to salvage chemotherapy. The chemotherapy regimens had included a platinum-based medication, such as cisplatin (Platinol). Patients were treated with blinatumomab and the steroid dexamethasone (Decadron), which can reduce inflammation from antibody therapy. Patients were followed for 4.9 months.

46% of patients completed the first cycle of blinatumomab, which lasted 70 days. Other patients stopped due to side effects or worsening of the cancer. 3 patients (7%) completed an optional second 28-day cycle.

37% of patients responded to blinatumomab. 9 patients (22%) had a complete response, meaning the cancer was no longer detectable. Among patients who responded to treatment, 64% were estimated to not have the cancer worsen after 9 months. 8 patients (20%) had a SCT. Among these patients, 80% were estimated to survive at least nine months.

The most frequent side effects were back pain (24%), fever (24%), and headache (22%). 71% of patients had at least one serious side effect, the most common of which was low white blood cell count (10%).

This study found that blinatumomab is an option for patients with relapsed aggressive B-cell NHL that did not respond to salvage chemotherapy.

This is a small study and included a low number of patients. More studies are needed to determine which second salvage treatment has the best outcomes. This study was funded by Amgen, the manufacturer of blinatumomab.