Blinatumomab may improve outcomes in patients with B-cell ALL undergoing ASCT

In a retrospective study, pre-transplantation blinatumomab was linked to better overall survival (OS) and reduced treatment-related mortality in patients with B-cell acute lymphoblastic leukaemia (ALL) undergoing allogeneic stem cell transplantation (ASCT). The authors emphasised that larger prospective trials are needed to confirm the results of the current retrospective study, which had a relatively small number of participants.

This retrospective study investigated the efficacy of pre-transplant blinatumomab in participants with B-cell ALL undergoing ASCT. Out of the 117 participants undergoing ASCT for B-cell ALL, 31 had received pre-transplant blinatumomab and 86 participants had not. Dr Ayman Sayyed (University of Toronto, Canada) presented the primary outcomes of OS and transplant-related mortality [1].

The median OS was 42 months in the blinatumomab group compared with 13 months in the non-blinatumomab group (HR 0.50; 95% CI 0.26–1.00; P=0.04; see Figure). Furthermore, a multivariate analysis showed that significant independent factors that positively influenced survival included blinatumomab (HR 0.48), total body irradiation (TBI)-based conditioning (HR 0.26), and paediatric-inspired induction protocol (HR 0.18). A mismatched donor was negatively associated with survival (HR 3.47). Considering transplant-related mortality, only 3.2% of the patients in the blinatumomab group had a transplant-related death compared with 43.0% of the patients in the non-blinatumomab group (HR 0.06; P=0.007).

The limitations of this retrospective study include that the blinatumomab and no-blinatumomab groups were not balanced with regard to patient and transplant characteristics. Further, the HCT regimen for nearly all patients in the blinatumomab group included T-cell depletion and PT-CY for GvHD prophylaxis, known to result in less severe acute GvHD, which may have contributed to the lower non-relapse mortality in the blinatumomab group.

“The effect of blinatumomab on OS and transplant-related mortality, confirmed by multivariate analysis, suggested that the reduction in transplant-related mortality is possibly related to a lower burden of treatment-related toxicity, experienced by patients who received fewer cytotoxic agents during induction therapy,” argued Dr Sayyed. “Larger prospective trials are needed to further clarify the role of blinatumomab in the context of patients with B-cell ALL undergoing AHCL.”

1. Sayyed A, et al. Pre-transplant blinatumomab improves outcomes in B-cell acute lymphoblastic leukemia patients who undergo allogeneic hematopoietic cell transplantation. OS06-05, European Society for Blood and Marrow Transplantation (EBMT) 49^th Annual Meeting, 23–26 April 2023, Paris, France.

Copyright ©2023 Medicom Medical Publishers



Posted on 14 June, 202315 February, 2024