Real-world outcomes of adult B-cell acute lymphocytic leukemia patients treated with blinatumomab

Talha Badar, Aniko Szabo, Anjali Advani, Martha Wadleigh, Shukaib Arslan, Muhammad Ali Khan, Ibrahim Aldoss, Caitlin Siebenaller, Elizabeth Schultz, Mehrdad Hefazi, Rory M. Shallis, Ilana Yurkiewicz, Nikolai Podoltsev, Anand A. Patel, Emily Curran, Suresh Balasubramanian, Jay Yang, Ryan J. Mattison, Madelyn Burkart, Shira DinnerMichaela Liedtke, Mark R. Litzow, Ehab Atallah

Research output: Contribution to journalArticle

Abstract

The availability and use of blinatumomab symbolizes a paradigm shift in the management of B-cell acute lymphoblastic leukemia (ALL). We conducted a retrospective multicenter cohort analysis of 239 ALL patients (227 relapsed refractory [RR], n 5 227; minimal residual disease [MRD], n 5 12) who received blinatumomab outside of clinical trials to evaluate safety and efficacy in the “real-world” setting. The median age of patients at blinatumomab initiation was 48 years (range, 18-85). Sixty-one (26%) patients had $3 prior therapies and 46 (19%) had allogeneic hematopoietic cell transplantation before blinatumomab. The response rate (complete remission/complete remission with incomplete count recovery) in patients with RR disease was 65% (47% MRD2). Among 12 patients who received blinatumomab for MRD, 9 (75%) patients achieved MRD negativity. In patients with RR disease, median relapse-free survival and overall survival (OS) after blinatumomab was 32 months and 12.7 months, respectively. Among patients who received blinatumomab for MRD, median relapse-free survival was not reached (54% MRD2 at 2 years) and OS was 34.7 months. Grade $3 cytokine release syndrome, neurotoxicity, and hepatotoxicity were observed in 3%, 7%, and 10% of patients, respectively. Among patients who achieved complete remission/complete remission with incomplete count recovery, consolidation therapy with allogeneic hematopoietic cell transplantation retained favorable prognostic significance for OS (hazard ratio, 0.54; 95% confidence interval, 0.30-0.97; P 5.04). In this largest “real-world” experience published to date, blinatumomab demonstrated responses comparable to those reported in clinical trials. The optimal sequencing of newer therapies in ALL requires further study.

Original languageEnglish (US)
Pages (from-to)2308-2316
Number of pages9
JournalBlood Advances
Volume4
Issue number10
DOIs
StatePublished - May 26 2020

ASJC Scopus subject areas

  • Hematology

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