Blinatumomab and Inotuzumab Ozogamicin Sequential Use for the Treatment of Relapsed/Refractory Acute Lymphoblastic Leukemia: A Real-Life Campus All Study

• Published in: Cancers 2023-09, Vol.15 (18), p.4623
• Main Authors: Fracchiolla, Nicola Stefano, Sciumè, Mariarita, Papayannidis, Cristina, Vitale, Antonella, Chiaretti, Sabina, Annunziata, Mario, Giglio, Fabio, Salutari, Prassede, Forghieri, Fabio, Lazzarotto, Davide, Lunghi, Monia, Imovilli, Annalisa, Scappini, Barbara, Bonifacio, Massimiliano, Dargenio, Michelina, Gurrieri, Carmela, Todisco, Elisabetta, Defina, Marzia, Del Principe, Maria Ilaria, Zappasodi, Patrizia, Cerrano, Marco, Santoro, Lidia, Tagliaferri, Elena, Barozzi, Enrico, De Roberto, Pasquale, Canzi, Marta, Buzzatti, Elisa, Sartor, Chiara, Passamonti, Francesco, Foà, Robin, Curti, Antonio
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Allografts; Antimitotic agents; Antineoplastic agents; Cancer; Care and treatment; Chemotherapy; Flow cytometry; Hematopoietic stem cells; Immunotherapy; Leukemia; Lymphatic leukemia; Lymphocytes; Lymphocytic leukemia; Medical prognosis; Minimal residual disease; Monoclonal antibodies; Oncology, Experimental; Patients; Remission; Remission (Medicine); Stem cell transplantation; Transplantation; Transplants & implants
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15184623

Blinatumomab (Blina) and inotuzumab ozogamicin (InO) has improved the outcome of relapsed/refractory B-lymphoblastic leukemia (R/R B-ALL). However, little is known about the outcome after recurrence and re-treatment with immunotherapy. We describe 71 R/R B-ALL patients treated for different relapses with Blina and InO. Blina was the first treatment in 57 patients and InO in 14. Twenty-seven patients had a previous allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the Blina/InO group, after Blina, 36 patients (63%) achieved a complete remission (CR), with 42% of negative minimal residual disease (MRD-); after InO, a CR was achieved in 47 patients (82%, 34 MRD-). In the InO/Blina group, after InO, 13 cases (93%) reached a CR (6 MRD-); after Blina, a CR was re-achieved in 6 cases (43%, 3 MRD-). Twenty-six patients proceeded to allo-HSCT. In the Blina/InO group, the median overall survival (OS) was 19 months; the disease-free survival (DFS) after Blina was 7.4 months (11.6 vs. 2.7 months in MRD- vs. MRD+, = 0.03) and after InO, 5.4 months. In the InO/Blina group, the median OS was 9.4 months; the median DFS after InO was 5.1 months and 1.5 months after Blina (8.7 vs. 2.5 months in MRD- vs. MRD+, = 0.02). With a median follow-up of 16.5 months from the start of immunotherapy, 24 patients (34%) are alive and 16 (22%) are alive in CR. In our series of R/R B-ALL, Blina and InO treatment demonstrate efficacy for subsequent relapses in terms of MRD response, OS and DFS, and as a bridge to allo-HSCT.