Frontline Blinatumomab in Older Adults with Philadelphia Chromosome-Negative B-Cell Acute Lymphoblastic Leukemia

Abstract

Outcomes of acute lymphoblastic leukemia (ALL) in older adults treated with chemotherapy are poor. The CD19/CD3 bispecific T-cell engager (BiTE) antibody blinatumomab is approved for refractory, relapsed or minimal/measurable residual disease (MRD)-positive B-cell ALL, but there is little experience in the upfront setting, including in older patients. We retrospectively analyzed outcomes of blinatumomab monotherapy in five newly diagnosed Philadelphia chromosome-negative B-cell ALL patients over 70 years. Three had cytokine release syndrome, treated with dexamethasone and/or tocilizumab, and four patients had neurotoxicity, treated with dexamethasone, without blinatumomab interruption. All five achieved complete remission (CR) after cycle one, three with undetectable MRD. All five were alive at 8 to 15 months. Three remained in MRD-negative CR. Two relapsed after cycle 3, one with extramedullary disease. In our small cohort of patients over 70 years, blinatumomab was safe initial therapy and produced a high response rate.

Long-Term Follow up of Blinatumomab in Older Patients with B-Cell Acute Lymphoblastic Leukemia

“…This long-term follow up report contains five patients ( Table 1 ), all of whom were the patients in the initial report [ 6 ]. Their ages ranged from 71 years to 86 years at the time of diagnosis.…”

“…Blinatumomab is a CD19/CD3 bispecific T-cell engager that is currently approved by the United States Food and Drug Administration (FDA) for CD19 positive B-cell ALL in first or second complete remission (CR) with measurable (or minimal) residual disease (MRD) positivity or in relapsed or refractory B-cell ALL. We previously reported on a small cohort of five patients at the University of Maryland Greenebaum Comprehensive Cancer Center who were treated with frontline blinatumomab, showing that it was well tolerated and effective in treating B-cell ALL as a first line therapy [ 6 ]. Here, we present a long-term (four years) follow up of their clinical courses.…”

CD19 chimeric antigen receptor-T cells as bridging therapy to allogeneic hematopoietic cell transplantation improves outcome in patients with refractory/relapsed B-cell acute lymphoblastic leukemia

“…Refractory/relapsed B-cell acute lymphoblastic leukemia (R/R B-ALL) presents a grave prognosis in patients of different ages, with a median survival expectation of less than 6 months and a reported 3-year overall survival (OS) rate of just 14–16 % [ 1 ]. Despite efforts with intensive chemotherapy, targeted drugs, and allogeneic hematopoietic stem cell transplantation (allo-HSCT), satisfactory remission rates have remained elusive [ [2] , [3] , [4] ]. There is an urgent need for new treatments.…”