Efficacy of blinatumomab as maintenance therapy for B-lineage acute lymphoblastic leukemia/lymphoma following allogeneic hematopoietic cell transplantation
Jiayu Huang, Bingyang Shi, Shiyou Yu, Mengxing Xue, Ling Wang, Jieling Jiang, Jiong Hu, Jun Zhu, Suning Chen, Lijing Shen, Weijie Cao, Yang Cao, Xiaoxia Hu
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a curative therapy for patients with high-risk B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) [ 1 ]. However, according to the EBMT database, the relapse rate of allo-HSCT recipients during their first complete remission (CR) can reach 22% [ 2 ], and post allo-HSCT relapse is associated with a disappointing remission rate and dismal outcomes [ 3 , 4 ]. Therefore, it is crucial to implement strategies to mitigate the risk of relapse after allo-HSCT. Tyrosine kinase inhibitors are widely used as effective maintenance treatments for Philadelphia (Ph)-positive B-ALL [ 1 , 5 ]. However, there are few reports on suitable maintenance therapies for Ph-negative B-ALL following allo-HSCT. A single-center retrospective study suggested those with Ph-negative B-ALL may benefit from decitabine maintenance following allo-HSCT, as decitabine more than halved the 3-year relapse rate (19.5% vs . 42.2%, P = 0.068) [ 6 ]. Prophylactic donor-derived CD19 CAR-T cell infusion after allo-HSCT was reported to significantly lower the 2-year cumulative incidence of relapse in high-risk B-ALL to 5.6% [ 7 ]. Recently, a phase 1 clinical trial was conducted to investigate the safety and efficacy of low-dose inotuzumab ozogamicin (INO) as a posttransplant maintenance [ 8 ]. INO demonstrated a favorable safety profile and 1-year progression-free survival (PFS) of 89%.