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Blinatumomab and/or inotuzumab as pre-HSCT salvage therapy in adult patients with R/R-ALL and MPAL
Achieving CR before allo-HSCT is crucial in improving survival in patients with R/R B-ALL; however, many patients do not respond to conventional chemotherapy, restricting their ability to proceed to transplantation. Blina/InO may offer improved efficacy over chemotherapy, enabling more patients to reach HSCT in remission. This single-center, retrospective study assessed outcomes in adult patients with R/R B-ALL or MPAL who underwent first HSCT (N = 70). Patients were grouped based on receiving Blina/InO (n = 22) or conventional chemotherapy (n = 48) before HSCT. The primary endpoint was OS. Key secondary endpoints included DFS, CIR, and NRM. Results were published by Kondo et al. in Leukemia Research.1
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Key learnings |
2 years post-HSCT, OS and DFS were significantly higher with Blina/InO vs chemotherapy (63.0% vs 31.2% and 49.6% vs 22.9%; p = 0.049), as were CR rates before HSCT (77.3% vs 35.4%; p = 0.002). |
CIR was comparable (41.3 % vs 47.9 %; p = 0.767). A lower tendency of NRM was observed with Blina/InO (9.1% vs 29.2%; p = 0.767). Non-CR status before HSCT was the only factor significantly associated with poor OS and higher CIR. |
Blina/InO was generally well tolerated; however, a higher incidence of VOD/SOS was observed vs chemotherapy 18.2% vs 0.0%, p = 0.003. In the InO-only group, the 2-year CIR of VOD/SOS was 33.3%. Acute GvVHD post HSCT was similar across groups. |
Blina/InO may improve pre-HSCT CR rates and post-HSCT outcomes in patients with R/R B-ALL/MPAL. Although associated with higher CR rates post salvage therapy, it may be particularly successful in enabling patients to proceed to HSCT in remission. Larger cohort evaluations are warranted. |
ALL, acute lymphoblastic leukemia; allo-HSCT, allogeneic hematopoietic stem cell transplantation; Blina, blinatumomab; CIR, cumulative incidence of relapse; CR, complete remission; DFS, disease-free survival; GVHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; InO, inotuzumab ozogamicin; MPAL, mixed-phenotype acute leukemia; NRM, non-relapse mortality; OS, overall survival; R/R, relapsed/refractory; SOS, sinusoidal obstruction syndrome; VOD, veno-occlusive disease.
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