Concomitant Use of Blinatumomab and Donor Lymphocyte Infusion for Mixed-Phenotype Acute Leukemia: A Case Report With Literature Review

Abstract

Blinatumomab and donor lymphocyte infusion (DLI) combination is a promising cancer therapy, whereby blinatumomab might achieve an initial reduction in leukemic-cell burden using T cells, and after tumor clearance, DLI can potentially stimulate the donor immune system to achieve longer lasting remission. Here, we present a 51-year-old female with mixed phenotype acute leukemia who had a hematologic relapse 3 months after she received total body irradiation-based myeloablative allogeneic hematopoietic stem cell transplantation from an unrelated human leukocyte antigen matched (10/10) donor and achieved complete remission with minimal residual disease negativity by multi-parameter flow cytometry using the combination of blinatumomab and DLI. To the best of our knowledge, this is the first report to describe the use of blinatumomab and DLI combination therapy in the treatment of B/myeloid mixed phenotype acute leukemia.

Second allogeneic stem cell transplantation in patients with acute lymphoblastic leukaemia: a study on behalf of the Acute Leukaemia Working Party of the European Society for Blood and Marrow Transplantation

“…A second allo‐HCT (allo‐HCT2) can achieve durable remissions in a subset of patients with relapsed acute leukaemia after a first allo‐HCT (allo‐HCT1) (Bosi et al , ; Poon et al , ; Vrhovac et al , ; Willasch et al , ; Durer et al , ). The shorter time to relapse (≤6 months) after allo‐HCT1 and active disease prior to allo‐HCT2 were associated with poor outcomes of relapsed ALL patients (Eapen et al , ; Poon et al , ).…”

Concurrent application of blinatumomab and haploidentical donor leukocyte infusions for refractory primary mediastinal large B-cell lymphoma

“…There is a single case report on concomitant use of DLI with blinatumomab following a matched unrelated donor transplant for leukemia but no reports in haploidentical HCT. 15 While our experience illustrates that blinatumomab can be used concurrently with DLI in a haploidentical setting, the relative contribution of DLI versus blinatumomab in achieving a metabolic CR was not clear. Our patient relapsed after discontinuing blinatumomab; however, he had also restarted prednisone because of worsening GvHD symptoms therefore GvL activity was likely suppressed.…”

Pediatric Mixed-Phenotype Acute Leukemia: What’s New?

“…There is growing evidence that these therapies can also be utilized in the treatment of MPAL. Recent case reports and small retrospective reviews support the use of CD19 BITE cells and CART cells as efficacious treatments for refractory MPAL [ 77 , 78 , 79 , 80 ]. A recent case series from Bartram et al out of the United Kingdom presented three pediatric cases of refractory MPAL that successfully utilized Blinatumomab as a bridge to transplant, including in a patient with a significant CD19-negative blast component [ 81 ].…”