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The addition of blinatumomab to prephase, consolidation, and after intensification in patients with B-ALL: updated results from the HOVON-146 trial

Jul 4, 2024
Learning objective: After reading this article, learners will be able to cite a new clinical development in B-cell ALL.

The phase II HOVON-146 trial (NCT03541083) is evaluating the addition of blinatumomab to prephase, consolidation, and after intensification in adult patients with B-cell acute lymphoblastic leukemia (B-ALL).1 Initial results from this trial were previously reported by the ALL Hub. Updated results after a median follow-up of 43 months, and a comparison with results from the HOVON-100 trial (NL-OMON28093), which used the same backbone without blinatumomab, were presented at the European Hematology Association (EHA) 2024 Hybrid Congress by Rijneveld.1 

Key learnings

The primary endpoint of measurable residual disease (MRD)-negativity rate after blinatumomab consolidation was met 

  • The complete remission (CR) and MRD-negativity rates were 97% and 91%, respectively. 

In the prephase, blinatumomab led to early response rates: the CR and MRD-negativity rates were 63% and 53%, respectively.  

After a median follow-up of 43 months, the event-free survival (EFS) rates in patients aged 40 years and >40 years were 64% and 40%, respectively, and the overall survival (OS) rates were 86% and 50%, respectively.  

In Philadelphia-positive (Ph+) patients and Philadelphia-negative patients, the EFS rates were 75% and 64%, respectively, and the OS rates were 85% and 70%. 

When results were compared with the HOVON-100 trial, the addition of blinatumomab to chemotherapy improved outcomes, particularly for patients aged >40 years and Ph+ patients.  

Substantial toxicity was observed in patients aged >60 years; however, after chemotherapy dose adaptations there were no further safety concerns.  

Further studies are warranted to assess the substitution of chemotherapy for blinatumomab, particularly for Ph+ and elderly patients, to potentially reduce toxicity and improve outcomes.  

  1. Rijneveld A. Blinatumomab added to prephase and consolidation therapy in adult B-ALL: a comparison of the consecutive HOVON-100 and H-146 studies. Abstract #S113. Presented at: European Hematology Association 2024 Hybrid Congress; Jun 13–16, 2024; Madrid, ES.  


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