Outcomes of relapsed B-cell acute lymphoblastic leukemia after sequential treatment with blinatumomab and inotuzumab Journal Article
| Authors: | Wudhikarn, K.; King, A. C.; Geyer, M. B.; Roshal, M.; Bernal, Y.; Gyurkocza, B.; Perales, M. A.; Park, J. H. |
| Article Title: | Outcomes of relapsed B-cell acute lymphoblastic leukemia after sequential treatment with blinatumomab and inotuzumab |
| Abstract: | Novel monoclonal antibody (mAb)-based therapies targeting CD19 and CD22 (blinatumomab and inotuzumab) have shown high rates of complete remission (CR) and been used as a bridging treatment to potentially curative allogeneic hematopoietic stem cell transplantation (alloHSCT) in adults with relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL). However, limited data exist on the outcome of patients resistant to both mAbs as well as responses to each agent when progressed after the alternate antigen-targeted mAb. Herein, we report outcomes of 29 patients with R/R B-ALL previously treated with both blinatumomab and inotuzumab. Twenty-five patients (86.2%) received blinatumomab as first mAb (mAb1), and CD19-negative/dim relapses were observed in 44% of the patients. Inotuzumab induced CR in 68% of the patients for post-blinatumomab relapse regardless of CD19 expression status. The median time between mAb1 and mAb2 was 99 days. Twelve (63.2%) of 19 patients who achieved remission after mAb2 underwent alloHSCT. The median time from mAb2 to alloHSCT was 37.5 days. Acute graft-versus-host disease and nonrelapse mortality were observed in 58.3% (grade 3 or higher, 25%) and 41.7%, respectively. With a median follow-up of 16.8 months after mAb2, 19 patients (65.5%) relapsed, and 21 patients (72.4%) have died. Overall survival was not different between alloHSCT and non-alloHSCT patients. In conclusion, patients with B-ALL who relapsed after blinatumomab could be successfully rescued by inotuzumab as a bridge to alloHSCT but represent an ultra-high-risk group with poor overall survival. Further studies, including novel consolidation and treatment sequence, may improve outcomes of these patients. © 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. |
| Keywords: | adult; cancer survival; clinical article; controlled study; treatment outcome; treatment response; overall survival; clinical feature; follow up; antigen expression; cohort analysis; medical record review; acute lymphoblastic leukemia; monoclonal antibody; acute graft versus host disease; clinical evaluation; remission; allogeneic hematopoietic stem cell transplantation; leukemia relapse; cd19 antigen; inotuzumab ozogamicin; mortality rate; blinatumomab; time to treatment; human; male; female; article |
| Journal Title: | Blood Advances |
| Volume: | 6 |
| Issue: | 5 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2022-03-08 |
| Start Page: | 1432 |
| End Page: | 1443 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2021005978 |
| PUBMED: | 35042232 |
| PROVIDER: | scopus |
| PMCID: | PMC8905691 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2022 -- Source: Scopus |
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