Clinical lymphoma, myeloma & leukemia · 2026
Pretransplant Blinatumomab Is Associated With Reduced Relapse and Improved Disease-Free Survival in Adults With B-Cell ALL Undergoing Allogeneic Hematopoietic Cell Transplantation.
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Ginosyan Anush A, Ashouri Karam, Chen Tiffany, Grove Sophie, Huang Elaine, Hom Brian, Nittur Vinay, Adnani Blake, Hwang Jennifer, Chu Mollee, Ireland Robert, Ann Brandon, Ford Lauren, Humayun Lucas, Kolanjian Arsine, Baya Mihir, Hong Danielle, Chaudhary Preet, Siddiqi Imran, Ali Amir, Woan Karrune, Tam Eric Leon, Yaghmour George
Аннотация
BACKGROUND: Adults with B-cell acute lymphoblastic leukemia (B-ALL) have inferior survival compared with pediatric patients, and pretransplant measurable residual disease (MRD) predicts relapse after allogeneic hematopoietic stem cell transplantation (HSCT). Blinatumomab, a bispecific CD3/CD19 antibody, may eradicate MRD, but its pretransplant impact is unclear.
OBJECTIVES: To evaluate the effect of pretransplant blinatumomab on survival, relapse, graft-versus-host disease (GVHD), and GVHD-free, relapse-free survival (GRFS) in this single-center retrospective cohort adult B-ALL patients.
PATIENTS AND METHODS: This single-center retrospective study included 145 predominantly Hispanic adults (≥18 years) with B-ALL who underwent HSCT between 2013 and 2025, with 56 receiving pretransplant blinatumomab and 89 controls. Outcomes were overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR), non-relapse mortality (NRM), GRFS, and grade III/IV acute and severe chronic GVHD.
RESULTS: Among 145 adults (median age 42 years), 76.6% were Hispanic and 38.6% received pretransplant blinatumomab. The 2-year OS and DFS for the cohort were 88.6% and 70.3%, respectively. Blinatumomab was associated with improved 2-year DFS (84.4% vs. 62.8%; HR 0.45; 95% CI, 0.21-0.97; P = .042) and reduced CIR (7.4% vs. 31.0%; HR 0.27; 95% CI, 0.09-0.77; P = .014) on univariate analysis. These benefits persisted on multivariate analysis adjusting for disease stage, cytogenetics, and MRD status (DFS: HR = 0.34; 95% CI, 0.15-0.80; P = .014; CIR: HR = 0.26; 95% CI, 0.09-0.74; P = .012). NRM, GRFS, and grade III/IV acute and severe chronic GVHD did not differ.
CONCLUSION: In this predominantly Hispanic adult B-ALL population, pretransplant blinatumomab safely reduces relapse risk and improves disease-free survival without increasing post-transplant toxicity.
OBJECTIVES: To evaluate the effect of pretransplant blinatumomab on survival, relapse, graft-versus-host disease (GVHD), and GVHD-free, relapse-free survival (GRFS) in this single-center retrospective cohort adult B-ALL patients.
PATIENTS AND METHODS: This single-center retrospective study included 145 predominantly Hispanic adults (≥18 years) with B-ALL who underwent HSCT between 2013 and 2025, with 56 receiving pretransplant blinatumomab and 89 controls. Outcomes were overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR), non-relapse mortality (NRM), GRFS, and grade III/IV acute and severe chronic GVHD.
RESULTS: Among 145 adults (median age 42 years), 76.6% were Hispanic and 38.6% received pretransplant blinatumomab. The 2-year OS and DFS for the cohort were 88.6% and 70.3%, respectively. Blinatumomab was associated with improved 2-year DFS (84.4% vs. 62.8%; HR 0.45; 95% CI, 0.21-0.97; P = .042) and reduced CIR (7.4% vs. 31.0%; HR 0.27; 95% CI, 0.09-0.77; P = .014) on univariate analysis. These benefits persisted on multivariate analysis adjusting for disease stage, cytogenetics, and MRD status (DFS: HR = 0.34; 95% CI, 0.15-0.80; P = .014; CIR: HR = 0.26; 95% CI, 0.09-0.74; P = .012). NRM, GRFS, and grade III/IV acute and severe chronic GVHD did not differ.
CONCLUSION: In this predominantly Hispanic adult B-ALL population, pretransplant blinatumomab safely reduces relapse risk and improves disease-free survival without increasing post-transplant toxicity.