Results of salvage therapy with mini-hyper-CVD and inotuzumab ozogamicin with or without blinatumomab in pre-B acute lymphoblastic leukemia

Journal of Hematology & Oncology

Research

Susan O’Brien¹  Jeffrey Jorgensen²  Rashmi Kanagal-Shamanna²  Sanam Loghavi²  Nitin Jain³  Nicholas J. Short³  Rebecca Garris³  Yesid Alvarado³  Farhad Ravandi³  Guillermo Garcia-Manero³  Hagop Kantarjian³  Jovitta Jacob³  Koji Sasaki³  Musa Yilmaz³  Fadi G. Haddad³  Tapan Kadia³  Elias Jabbour³  Shilpa Paul⁴  Bouthaina Dabaja⁵  Partow Kebriaei⁶  Issa Khouri⁶ 

[1] Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA, USA;Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 77030, Houston, TX, USA;Department of Leukemia, The University of Texas MD Anderson Cancer Center, Box 428, 1515 Holcombe Blvd., 77030, Houston, TX, USA;Department of Pharmacy, The University of Texas MD Anderson Cancer Center, 77030, Houston, TX, USA;Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 77030, Houston, TX, USA;Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, 77030, Houston, TX, USA;

关键词: Philadelphia-negative ALL;    Inotuzumab;    Blinatumomab;    Chemo-immunotherapy;    Salvage;    Outcome;   

DOI  :  10.1186/s13045-023-01444-2

 received in 2023-02-20, accepted in 2023-04-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHistorically, adults with relapsed-refractory acute lymphoblastic leukemia (ALL) experienced poor outcomes with intensive chemotherapy. This mature analysis explores the benefit of the addition of sequential blinatumomab to low-intensity mini-Hyper-CVD chemotherapy with inotuzumab ozogamicin in this setting.MethodsMini-Hyper-CVD (cyclophosphamide and dexamethasone at 50% dose reduction, no anthracycline, methotrexate at 75% dose reduction, cytarabine at 83% dose reduction) was combined with inotuzumab during the first 4 courses. From Patient #68 and onwards, inotuzumab was given in reduced and fractionated doses, and blinatumomab was added sequentially for 4 courses. Maintenance therapy with prednisone, vincristine, 6-mercaptopurine and methotrexate was given for 12 courses, and blinatumomab for 4 additional courses.ResultsAmong 110 patients (median age, 37 years) treated, 91 (83%) responded (complete response, 69 patients, 63%). Measurable residual disease negativity was documented in 75 patients (82% of responders). Fifty-three patients (48%) received allogeneic stem cell transplantation (SCT). Hepatic sinusoidal obstruction syndrome occurred in 9/67 patients (13%) on the original inotuzumab schedule and in 1/43 (2%) on the modified schedule. With a median follow-up of 48 months, the median overall survival (OS) was 17 months, and the 3 year OS was 40%. The 3 year OS was 34% with mini-Hyper-CVD plus inotuzumab and 52% with additional blinatumomab (P = 0.16). By landmark analysis at 4 months, the 3 year OS was 54%, similar between patients who did or did not receive allogeneic SCT.ConclusionLow-intensity mini-Hyper-CVD plus inotuzumab with or without blinatumomab showed efficacy in patients with relapsed-refractory ALL, with better survival after the addition of blinatumomab.Trial registration The trial was registered on clinicaltrials.gov with the identifier NCT01371630.

【 授权许可】

CC BY   
© The Author(s) 2023

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