Blinatumomab for Acute Lymphoblastic Leukemia Relapse after Allogeneic Hematopoietic Stem Cell Transplantation

Anthony S. Stein, Hagop Kantarjian, Nicola Gökbuget, Ralf Bargou, Mark R. Litzow, Alessandro Rambaldi, Josep Maria Ribera, Alicia Zhang, Zachary Zimmerman, Gerhard Zugmaier, Max S. Topp

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5 Scopus citations

Abstract

Patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) following allogeneic hematopoietic stem cell transplantation (alloHSCT) have a poor prognosis, and alternative therapies are needed for this patient population. Blinatumomab, a bispecific T cell engager immunotherapy, was evaluated in an open-label, single-arm, phase II study of adults with R/R Philadelphia chromosome-negative B cell precursor ALL and resulted in a rate of complete remission (CR) or CR with partial hematologic recovery of peripheral blood counts (CRh) of 43% within 2 treatment cycles. We conducted an exploratory analysis to determine the efficacy and safety of blinatumomab in 64 patients who had relapsed following alloHSCT before enrollment in the phase II study. Forty-five percent of the patients (29 of 64) achieved a CR/CRh within the first 2 cycles of treatment, 22 of whom had a minimal residual disease (MRD) response (including 19 with a complete MRD response). After 1 year and 3 years of follow-up, the median relapse-free survival was 7.4 months for patients who achieved CR/CRh in the first 2 cycles, and the median overall survival was 8.5 months; overall survival rate (Kaplan-Meier estimate) was 36% at 1 year and 18% at 3 years. Grade 3 and 4 adverse events were reported in 20 patients (31%) and 28 patients (44%), respectively, with grade 3 and 4 neurologic events in 8 and 2 patients, respectively, and grade 3 cytokine release syndrome in 2 patients. Eight patients had fatal adverse events, including 5 due to infections. Seven patients had grade ≤ 3 graft-versus-host disease during the study, none of which resulted in the discontinuation of blinatumomab or hospitalization. Our data suggest that blinatumomab is an effective salvage therapy in this patient population.

Original languageEnglish (US)
Pages (from-to)1498-1504
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number8
DOIs
StatePublished - Aug 2019

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Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Blinatumomab
  • Efficacy
  • Philadelphia chromosome-negative B precursor ALL
  • Safety

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Stein, A. S., Kantarjian, H., Gökbuget, N., Bargou, R., Litzow, M. R., Rambaldi, A., Ribera, J. M., Zhang, A., Zimmerman, Z., Zugmaier, G., & Topp, M. S. (2019). Blinatumomab for Acute Lymphoblastic Leukemia Relapse after Allogeneic Hematopoietic Stem Cell Transplantation. Biology of Blood and Marrow Transplantation, 25(8), 1498-1504. https://doi.org/10.1016/j.bbmt.2019.04.010