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Multi-institutional study evaluating clinical outcome with allogeneic hematopoietic stem cell transplantation after blinatumomab in patients with B-cell acute lymphoblastic leukemia: real-world data

Bone Marrow Transplantation volume 56, pages 1998–2004 (2021)Cite this article

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Abstract

Safety and efficacy of allogeneic hematopoietic stem cell transplantation (alloHCT) consolidation after blinatumomab is largely undetermined. To address this issue, we assembled multi-center data of relapsed refractory (RR) acute lymphocytic leukemia (ALL) patients who received alloHCT after blinatumomab. From December 2014 to May 2019, 223 patients who received blinatumomab for RR ALL outside clinical trials were identified. Among them, 106 (47%) patients transplanted post blinatumomab were evaluated for response and toxicity. Ninety-two (87%) patients received alloHCT after achieving CR, while remaining received subsequent salvage prior to undergoing alloHCT. Progression free survival (PFS) and overall survival (OS) at 2 years post alloHCT was 48% (95% CI: 36–59%) and 58% (95% CI: 45–69%), respectively. The cumulative incidence of GIII–IV aGVHD at 3 months was 9.9% (95% CI: 5.0–16.6%). Similarly, cumulative incidence of moderate to severe cGVHD at 2 years was 34.4% (95% CI: 23.7–45.3%). The overall survival at 2 years was not significantly different in patient who achieved CR with MRD negative (68.4% [95% CI: 28.5–89.1%]) compared to CR with MRD positive (63.4% [95% CI: 47.8–75.4%]) prior to alloHCT (p = 0.8). Our real-world analysis suggests that alloHCT is feasible and effective post blinatumomab in patients with RR ALL.

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Fig. 1: Kaplan–Meier survival curve for progression free survival and overall survival post allogeneic hematopoietic stem cell transplant.
Fig. 2: Figure illustrates cumulated incidence of acute GVHD, chronic GVHD and probability of GVHD-relapse free survival (GRFS).
Fig. 3: Kaplan–Meier survival curve for progression free survival and overall survival post allogeneic hematopietic stem cell transplant in patients with or without minimal residual disease (MRD).

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Funding

AA—Macrogenics, Abbvie, Glycomimetics, Abbvie, Seattle Genetics, Immunogen, Amgen, Pfizer; Honoraria/ Advisory boards: Kite, Seattle Genetics, Pfizer, Amgen, Glycomimetcs

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Authors and Affiliations

  1. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Talha Badar, Aniko Szabo & Ehab Atallah

  2. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Mark Litzow & Mehrdad Hefazi

  3. Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, IL, USA

    Madelyn Burkart & Shira Dinner

  4. Stanford University Cancer Center, Stanford, CA, USA

    Ilana Yurkiewicz & Michaela Liedtke

  5. Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA

    Rory M. Shallis & Nikolai Podoltsev

  6. Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA

    Anand A. Patel & Emily Curran

  7. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Martha Wadleigh

  8. Karmanos Cancer Institute, Detroit, MI, USA

    Suresh Balasubramanian & Jay Yang

  9. Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA

    Shukaib Arslan & Ibrahim Aldoss

  10. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

    Ryan Mattison

  11. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Danielle Cenin, Caitlin Siebenaller & Anjali Advani

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  1. Talha Badar
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Correspondence to Talha Badar.

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Conflict of interest

TB received Mayo Clinic Cancer Center support grant (P30 CA015083) and in advisory board for Pfizer, NAP consulted for and received honoraria from Alexion, Pfizer, Agios Pharmaceuticals, Blueprint Medicines, Incyte, Novartis, Celgene, Bristol-Myers Squib, CTI BioPharma and PharmaEssentia. NAP received research funding (all to the institution) from Boehringer Ingelheim, Astellas Pharma, Daiichi Sankyo, Sunesis Pharmaceuticals, Jazz Pharmaceuticals, Pfizer, Astex Pharmaceuticals, CTI biopharma, Celgene, Genentech, AI Therapeutics, Samus Therapeutics, Arog Pharmaceuticals, Kartos Therapeutics. None of these relationships were related to the development of this paper.

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Badar, T., Szabo, A., Litzow, M. et al. Multi-institutional study evaluating clinical outcome with allogeneic hematopoietic stem cell transplantation after blinatumomab in patients with B-cell acute lymphoblastic leukemia: real-world data. Bone Marrow Transplant 56, 1998–2004 (2021). https://doi.org/10.1038/s41409-021-01279-w

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