Leukemic Optic Nerve Infiltration Responds to Radiation and Blinatumomab

Verter, Erol; Yang, Alina; Pointdujour-Lim, Renelle

doi:10.1016/j.ophtha.2018.01.024

Cited by 3 publications

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“…There are cases of patients who had disabling symptoms due to the disease that resolved after administration of blinatumomab. For example, one case of decreased visual acuity due to leukaemic cell infiltration of the optic nerves 92 improved on blinatumomab. There is also a case of severe liver failure (due to chemotherapy treatments) that resolved on blinatumomab (transaminase increase at the beginning of the infusion and then resolution) 93 …”

Section: Resultsmentioning

confidence: 99%

The pharmacology of blinatumomab: state of the art on pharmacodynamics, pharmacokinetics, adverse drug reactions and evaluation in clinical trials

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Mossazadeh

Lapierre

et al. 2022

Clinical Pharmacy Therapeu

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What is known and objective Bispecific drugs (BDs) belong to the family of immunotherapies along with checkpoint inhibitors and CAR‐T cells. In the field of oncology, BDs are designed to simultaneously bind a tumour antigen on the one side and an antigen present on the surface of effector cells on the other. This review summarizes the information available to date on the first marketed BiTE‐format bispecific antibody, blinatumomab BLINCYTO® in acute lymphoblastic leukaemia. Methods A literature search was conducted in the PubMed database by including studies published in English using the term blinatumomab. Furthermore, bibliographies of selected references were also evaluated for relevant articles. Clinical trial (CT) data were retrieved from clinicaltrials.gov (ongoing trials, adverse events [AEs]) and global pharmacovigilance data were retrieved from VigiBase®. Results and discussion Blinatumomab is a fusion protein which consists of two single‐chain variable fragments arranged in tandem: the first binds the CD19 surface antigen of all B cells and the second targets the CD3 antigen of T cells. Binding of blinatumomab to B and T cells induces apoptosis of B cells after secretion of granzymes and perforins by T cells. T‐cell activation results in secretion of pro‐inflammatory cytokines and upregulation of activation markers and adhesion molecules on the surface of T cells. The major CTs that led to an indication show increased overall survival with blinatumomab with better efficacy in patients in haematological remission with minimal residual disease ≥10−3. The major AEs are cytokine release syndrome, neurotoxicity and hypogammaglobulinemia. The three most frequent system organ classes in CTs are haematological, gastrointestinal and general disorders. These results are also found in VigiBase® but neurological disorders and infections appear more frequently in real life. What is new and conclusion This review summarizes the current knowledge of blinatumomab in the literature. The subject of many CTs is to improve the route of administration and expand the indications for treatment.

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Section: Resultsmentioning

confidence: 99%

The pharmacology of blinatumomab: state of the art on pharmacodynamics, pharmacokinetics, adverse drug reactions and evaluation in clinical trials

Mocquot

Mossazadeh

Lapierre

et al. 2022

Clinical Pharmacy Therapeu

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“…Although findings sometimes occurred in the setting of known CNS leukemia, they more often heralded a change in clinical condition, including relapse, new CNS involvement, or even initial leukemic blast crisis. Cases of neuro-ophthalmic involvement indicating leukemia relapse in patients believed to be in clinical remission have been previously reported (8)(9)(10)(11)(12), as have rare cases of visual changes secondary to bilateral leukemic infiltration of the optic nerves as the presenting symptom of ALL (13,14). However, most of these have been single case reports, with only 1 series of 3 cases.…”

Section: Discussionmentioning

confidence: 99%

Neuro-Ophthalmic Manifestations of Acute Leukemia

Alrobaian¹,

Henderson²

2020

Journal of Neuro-Ophthalmology

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Background: Ophthalmic involvement in acute leukemia is common, with 36% of patients having ophthalmic involvement at the time of diagnosis. However, neuro-ophthalmic involvement is relatively rare. We present a characterization of neuro-ophthalmic findings in patients with acute leukemia and discuss the implications of these findings on patient management and prognosis. Methods: We performed a retrospective review of cases of acute leukemia with central nervous system (CNS) involvement and neuro-ophthalmic manifestations that were evaluated at the Wilmer Eye Institute between January 2013 and September 2019. Data collected included demographic information, leukemia details, results of diagnostic testing, and features of associated neuro-ophthalmic manifestations.Results: Twelve patients with mean age 42 years (range 9-65, median 39) were included. Seven (58%) patients were men and 5 (42%) women. Eight (67%) were diagnosed with acute myeloid leukemia and 4 (33%) with acute lymphoid leukemia. Neuro-ophthalmic findings included 4 patients with isolated sixth nerve palsies, 2 with multiple cranial nerve palsies, 2 with orbital lesions with proptosis, 4 with optic disc swelling, and 1 with isolated fourth nerve palsy. Five (42%) neuro-ophthalmic presentations were associated with known CNS disease, 3 (25%) were associated with active disease but heralded the discovery of CNS involvement, 3 (25%) were the presenting features of relapse, and 1 (8%) led to the original leukemia diagnosis. Neuroimaging showed 4 with leptomeningeal enhancement, 4 with cranial nerve enhancement/thickening, 3 with optic nerve/sheath enhancement, 1 with lytic lesion of bone, 1 with soft tissue mass, and 1 with cytotoxic brain edema. One case had normal neuroimaging. Overall, patients had a poor prognosis, with 7 patients dying from leukemia or its complications and only 1 achieving a sustained remission. In 58% of the cases in our series, the discovery of neuro-ophthalmic leukemic involvement directly led to a change in leukemia treatment.Conclusions: Neuro-ophthalmic manifestations of leukemia may occur as presenting features of diagnosis, relapse, or CNS involvement, and portend a poor prognosis. Detection of neuro-ophthalmic involvement often triggers a prompt change in management. Therefore, familiarity with potential neuro-ophthalmic presentations of acute leukemia may avoid delayed diagnosis, and resultant inadequate treatment, of primary disease, relapse, or CNS involvement.

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Leukemic Infiltration of the Optic Nerve

McDonnell

Henderson

2021

Controversies in Neuro-Ophthalmic Management

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Leukemic Optic Nerve Infiltration Responds to Radiation and Blinatumomab

Cited by 3 publications

References 0 publications

The pharmacology of blinatumomab: state of the art on pharmacodynamics, pharmacokinetics, adverse drug reactions and evaluation in clinical trials

The pharmacology of blinatumomab: state of the art on pharmacodynamics, pharmacokinetics, adverse drug reactions and evaluation in clinical trials

Neuro-Ophthalmic Manifestations of Acute Leukemia

Leukemic Infiltration of the Optic Nerve

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