The ABCs of Immunotherapy for Adult Patients With B-Cell Acute Lymphoblastic Leukemia

Abstract

Outcomes of patients with relapsed disease are improving thanks to new therapies such as blinatumomab, inotuzumab, and CAR T-cells. Although the efficacy of these therapies is impressive, they are not without toxicity, both physical and financial. The optimal sequencing of these therapies still remains a question.

New targets for therapy: antigen identification in adults with B-cell acute lymphoblastic leukaemia

“…Phase I/II and III trials have shown promising results with high numbers of patients achieving minimal residual disease negative status and impressive rates of complete remission [3,8,9]. High response rates allow more patients to proceed to HSCT [9], it is better than standard salvage chemotherapy in R/R patients, and has efficacy when used in combination with low-dose chemotherapy for older adults with newly diagnosed ALL (NCT0371630) [10] but without additional toxicity. A concern with inotuzumab ozogamicin has been the incidence of veno-occlusive disease [8][9][10] and liverrelated toxicities [7,9,10] that can be ameliorated by careful patient management.…”

“…High response rates allow more patients to proceed to HSCT [9], it is better than standard salvage chemotherapy in R/R patients, and has efficacy when used in combination with low-dose chemotherapy for older adults with newly diagnosed ALL (NCT0371630) [10] but without additional toxicity. A concern with inotuzumab ozogamicin has been the incidence of veno-occlusive disease [8][9][10] and liverrelated toxicities [7,9,10] that can be ameliorated by careful patient management. However, the safety analysis showed that patients treated with inotuzumab ozogamicin had less thrombocytopenia and less febrile neutropenia than those on standard therapy [9].…”

“…A concern with inotuzumab ozogamicin has been the incidence of veno-occlusive disease [8][9][10] and liverrelated toxicities [7,9,10] that can be ameliorated by careful patient management. However, the safety analysis showed that patients treated with inotuzumab ozogamicin had less thrombocytopenia and less febrile neutropenia than those on standard therapy [9].…”

“…Blinatumomab was the first-approved BiTE to be used to treat ALL [7,11,12]. Phase I/II and phase III trials conducted with blinatumomab described better results for patients in terms of complete remission, minimal residual disease responses, response rates and survival [9]. Blinatumomab has been associated with some adverse events, such as neutropenia, infections, liver-associated disorders, neurological events, cytokine release syndrome (CRS), infusion reactions and lymphopenia in B-ALL patients.…”

Building Canadian capacity for CAR‐T cells in relapsed/refractory acute lymphoblastic leukaemia: a retrospective cohort study

“…Blinatumomab, a novel agent approved for relapsed or refractory B-cell ALL was not available at the time of this cohort analysis and could potentially reduce the number of patients needing anti-CD19 CAR-T cells. 21 Results have been promising with complete remission with blinatumomab of 30-45% of patients, but it remains unclear how durable these remissions will be. 22,23 Second, inotuzumab ozogomycin was also not available at the time of this analysis but is another therapy with promising results in ALL.…”