Sequencing antigen‐targeting antibodies and cellular therapies in adults with relapsed/refractory B‐cell acute lymphoblastic leukemia

Abstract

The recent approvals of four CD19‐or CD22‐targeted therapies for B‐cell acute lymphoblastic leukemia (B‐ALL) have transformed the treatment of relapsed/refractory (r/r) disease. Adults with r/r B‐ALL are usually eligible for all options, but there are no studies directly comparing these agents, and the treating physician must decide which to select. Each therapy has notable activity as a single agent but has limitations in particular settings, and the optimal choice varies. These therapies can be complementary and used either sequentially or concomitantly. Here, we review the current landscape of antigen‐targeted therapies for r/r B‐ALL and discuss considerations for their use.

Outcomes following allogeneic hematopoietic cell transplantation relapse in Philadelphia chromosome‐positive acute lymphoblastic leukemia

“…5 Although our univariate and multivariate analyses did not show the superiority of ponatinib versus older generation TKIs when used as the first TKI post-HCT relapse, it should be highlighted that older TKIs were more commonly used for MRD relapse only patients, and that many patients received ponatinib for subsequent relapses after the initial HCT relapse, which affected our analysis. Moreover, although utilization of novel immunotherapies was limited, encouraging response and MRDnegativity rates were noted as previously documented in Philadelphianegative ALL post-HCT relapse, 3 while the use of immunotherapy for management of the first relapse post-HCT led to superior PFS.…”

“…Recent advancements in allogeneic HCT techniques, such as improved supportive care, increasing use of reduced intensity conditioning over myeloablative regimens and alternative donors to matched siblings, 2 the availability of more potent tyrosine kinase inhibitors (TKI), increasing use of TKI maintenance post-HCT, and the accessibility to novel salvage immunotherapeutics, including blinatumomab, inotuzumab ozogamicin (InO), and chimeric antigen receptor T-cell therapy, have improved outcomes in Ph+ ALL patients. 1,3 While outcomes with these newer therapies have been described in patients with Philadelphia-negative ALL who relapsed after HCT, there are no reports describing the outcomes with these therapies in patients with Ph+ ALL who relapse after HCT. Herein, we report the City of Hope (COH) experience in managing Ph+ ALL post-HCT relapse.…”

Results of the compassionate program of inotuzumab ozogamicin for adult patients with relapsed or refractory acute lymphoblastic leukemia in Spain

“…There is also evidence of the benefit of IO in patients with positive MRD 19 . The administration of IO in newly diagnosed ALL or as first salvage regimen in association with other immunotherapies 20 and cellular therapies will improve the results of therapy in patients with B‐ALL.…”