Timing of intrathecal chemotherapy and blinatumomab impacts neurotoxicity in acute lymphoblastic leukemia

Lee, Benjamin J.; Griffin, Shawn; Doh, Jean; Kongtim, Piyanuch; Chan, Alexandre; O’Brien, Susan; Jeyakumar, Deepa; Ciurea, Stefan O.

doi:10.1002/ajh.26880

Cited by 2 publications

(1 citation statement)

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“…Patients with MRD > 0.01% at the end of consolidation (EOC) should receive blinatumomab or re-intensification chemotherapy to attain MRD negativity and should be considered for HCT as consolidation therapy. Moreover, it is not advisable to administer intrathecal chemotherapy concurrently with blinatumomab treatment due to an increased risk of neurotoxicity [ 18 ]. In a phase III trial, secondary hypogammaglobulinemia was recently reported in 16% of blinatumomab-treated patients with R/R ALL compared to 1% in patients who received chemotherapy [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Blinatumomab in Children with MRD-Positive B-Cell Precursor Acute Lymphoblastic Leukemia: A Report of 11 Cases

Wang,

Chang,

Wen

et al. 2024

Hematology Reports

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Background/Objectives: Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains an unresolved matter of concern regarding adverse outcomes. This case study aimed to evaluate the effectiveness of blinatumomab, with or without door lymphocyte infusion (DLI), in treating measurable residual disease (MRD)-positive B-ALL. Methods: All patients who received blinatumomab salvage therapy were included in this study. Eleven patients were included in the study. All patients were evaluated for MRD-negativity. Results: Before starting blinatumomab therapy, seven patients tested positive for MRD, three tested negative, and one had refractory disease. Hematopoietic cell transplantation (HCT) was reserved for five patients with persistent MRD. Six patients became MRD-negative and subsequent HCT was not performed. Only two patients relapsed; one patient died of relapse, and the other one received carfilzomib-based therapy and was MRD-negative thereafter. Nine patients were MRD-negative at a median follow-up of 28 months (15–52 months). Two of three MRD-positive post-transplant patients remained in complete molecular remission after preemptive DLI at the last follow-up date. In the first salvage, blinatumomab may achieve complete remission and bridging to HCT in pediatric patients with end-of-induction MRD-positive B-cell precursor ALL. Conclusions: The decision on how to treat post-transplant relapse continues to affect survival outcomes. Blinatumomab combined with DLI may extend the armamentarium of release options for high-risk pediatric patients. This approach is encouraging for high-risk ALL patients who are MRD-positive post-transplantation.

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Section: Discussionmentioning

confidence: 99%