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2024-05-16T13:17:38.000Z

The effect of blinatumomab prior to allo-HSCT in adult patients with B-ALL

May 16, 2024
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Learning objective: After reading this article, learners will be able to cite a new clinical development in ALL.

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Adult patients with acute lymphoblastic leukemia (ALL) have a poor prognosis, and 5-year overall survival (OS) in adults aged >50 years is 20%. Blinatumomab has shown efficacy in patients with relapsed/refractory B-cell ALL (B-ALL) and has achieved minimal residual negativity; however, there are limited data on the impact of pretransplant blinatumomab in adults.

Here, we summarize a retrospective study on the effect of blinatumomab prior to allogeneic stem cell transplantation (allo-HSCT) in adult patients with B-ALL, published by Sayyed et al.1 in Transplantation and Cellular Therapy.

Study design1

  • This retrospective study included adult patients with B-ALL who underwent allo-HSCT at the Princess Margaret Hospital, Toronto, CA, between January 2010 and December 2021.
  • The study endpoints included OS, cumulative incidence of relapse, non-relapse mortality (NRM), and graft-versus-host disease and relapse-free survival (GRFS).

Key findings1

Patient baseline characteristics

  • A total of 117 patients were included in the analysis, of which 31 patients received blinatumomab before allo-HSCT
  • Key baseline characteristics differed between the two cohorts, as summarized in Table 1

Table 1. Patient baseline characteristics*

Characteristic, %

Overall
(N = 117)

Blinatumomab
(n = 31)

No blinatumomab
(n = 86)

p value

Diagnosis

 

 

 

p = 0.01

              Ph-negative

57.3

77.4

50

 

              Ph-positive

42.7

22.6

50

 

Disease-risk index

 

 

 

p < 0.001

              Intermediate

68.4

35.5

80.2

 

              High

30.8

61.3

19.8

 

              Very high

0.8

3.2

0

 

Indication for transplant

 

 

 

p < 0.001

              Relapse

29.9

54.8

20.9

 

              Primary induction failure

16.2

41.9

7.0

 

               Chemotherapy intolerance

2.7

0

3.5

 

               High-risk features

39.3

0

53.5

 

               Therapy-related

8.5

3.2

10.5

 

              MRD positivity after               chemotherapy

3.4

0

4.7

 

Dual T-cell depletion

 

 

 

p = 0.005

              Yes

39.3

61.3

31.4

 

              No

60.7

38.7

68.6

 

PTCy-based GVHD prophylaxis

 

 

 

p < 0.001

               Yes

45.3

80.6

32.6

 

               No

54.7

19.4

67.4

 

Lines of treatment before transplant

 

 

 

p < 0.001

              1

49.6

0

67.4

 

              2

41.0

64.5

32.6

 

              3

7.7

29.0

0

 

              4

1.7

6.5

0

 

Year of transplant

 

 

 

p < 0.001

              20102015

72

57

95

 

              20162021

15

22

5

 

GvHD, graft-versus-host disease; MRD, minimal residual disease; Ph, Philadelphia chromosome; PTCy, post-transplant cyclophosphamide

*Adapted from Sayyed, et al.1

Survival and relapse outcomes

  • After a median follow-up of 36 months,
    • 2-year OS, GRFS, and the cumulative incidence of relapse was significantly higher in patients who received blinatumomab vs those who did not (Figure 1); and
    • the 2-year NRM and Grade 24/Grade 34 acute graft-versus-host disease at Day 100 was significantly lower in patients who received blinatumomab prior to allo-HSCT versus those who did not (Figure 1).
  • The incidence of Grade 2−4 and Grade 3−4 acute graft-versus-host disease in the total cohort was 48.9% and 27.8%, respectively.
  • Multivariate analysis revealed a significant association between pretransplant blinatumomab and improved OS and NRM.

Figure 1. 2-year outcomes in blinatumomab treated vs no blinatumomab groups* 

aGvHD, acute graft-versus-host disease; CIR, cumulative incidence of relapse; GRFS, GvHD-free and relapse-free survival; NRM, non-relapse mortality; OS, overall survival
*Data from Sayyed, et al.1

 

Key learnings
  • Despite the small sample size, blinatumomab prior to allo-HSCT was associated with improved OS and reduced NRM in adult patients with B-ALL
  • Larger prospective studies are needed to confirm these findings

  1. Sayyed A, Chen C, Gerbitz A, et al. Pretransplant Blinatumomab improves outcomes in B cell acute lymphoblastic leukemia patients who undergo allogeneic hematopoietic cell transplantation. Transplant Cell Ther. 2024;30(5):520.e1-520.e12. DOI: 10.1016/j.jtct.2024.03.00

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