Impact of prior blinatumomab response on brexu-cel outcomes in R/R B-ALL

Results from a real-world retrospective analysis of the Real-World Outcomes Collaborative of chimeric antigen receptor (CAR)-T in Adult ALL (ROCCA) consortium, evaluating the impact of prior blinatumomab response on brexucabtagene autoleucel (brexu-cel) outcomes in 278 adults with relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL), were published in Blood by Srinagesh et al. Patients were grouped as blinatumomab-naïve (no-B; n = 115), responders (B-R; n = 102), or non-responders (B-NR; n = 54). Endpoints included progression-free survival (PFS), overall survival (OS), and safety.

Key data: Among patients evaluable at Day 28 (n = 254), 90% achieved CR/CRi after brexu-cel, regardless of blinatumomab history. Adjusted PFS was lower in the B-NR (hazard ratio [HR], 1.94, 95% confidence interval [CI], 1.19–3.17; p = 0.008) and B-R groups (HR, 1.56, 95% CI, 1.08–2.27; p = 0.019) vs the no-B group. Adjusted OS was lower in the B-NR vs no-B group (HR, 2.05; p = 0.015). Cytokine release syndrome (CRS) was more frequent in the B-NR vs B-R vs no-B groups (98%, 84%, 81%, respectively; p = 0.014).

Key learning: Lack of response to prior blinatumomab, rather than exposure alone, is associated with inferior survival following brexu-cel in adults with R/R B-ALL, identifying a high-risk population.