Clinical lymphoma, myeloma & leukemia · 2025
Blinatumomab Versus Chemotherapy for Post-Induction Consolidation in First Relapse of B-Cell Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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da Silva Anderson Matheus Pereira, Filho Luciano Falcão Carneiro, Han Mariana Lee, Menezes Isabelle Rodrigues, de Farias Elizabeth Honorato, Leite Marianna, Santos do Nascimento Maria da Vitória, Franco Eryvelton de Souza, Maia Maria Bernadete de Sousa
Аннотация
BACKGROUND: Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains a therapeutic challenge, particularly in children, adolescents, and young adults. Blinatumomab, a bispecific T-cell engager targeting CD19-positive leukemic cells, has emerged as an alternative to conventional chemotherapy in post-induction consolidation. This meta-analysis aimed to evaluate its impact on survival outcomes, relapse rates, and treatment-related toxicities.
METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing blinatumomab to chemotherapy as post-induction consolidation therapy in children, adolescents, and young adults with first relapse of standard-risk B-ALL were included. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Secondary outcomes included cumulative incidence of relapse, measurable residual disease (MRD) negativity, hematopoietic stem cell transplantation (HSCT) eligibility, and treatment-related toxicities. Effect sizes were estimated using hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI).
RESULTS: Four RCTs including 703 patients were analyzed. Blinatumomab was associated with improved disease-free survival (DFS) (HR 0.59; 95% CI, 0.42-0.81) and OS (HR 0.57; 95% CI, 0.43-0.76), as well as a lower cumulative incidence of relapse (HR 0.26; 95% CI, 0.16-0.41). Referral for HSCT was more frequent in the blinatumomab group (RR 1.43; 95% CI, 1.10-1.85). Furthermore, blinatumomab was associated with a higher rate of measurable residual disease (MRD) negativity at the end of the first consolidation cycle (RR 1.96; 95% CI, 1.40-2.76).
CONCLUSION: Blinatumomab improved survival outcomes and increased the proportion of patients referred for HSCT, supporting its role as post-induction consolidation therapy for relapsed B-ALL in paediatric and young adult populations.
METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing blinatumomab to chemotherapy as post-induction consolidation therapy in children, adolescents, and young adults with first relapse of standard-risk B-ALL were included. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Secondary outcomes included cumulative incidence of relapse, measurable residual disease (MRD) negativity, hematopoietic stem cell transplantation (HSCT) eligibility, and treatment-related toxicities. Effect sizes were estimated using hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI).
RESULTS: Four RCTs including 703 patients were analyzed. Blinatumomab was associated with improved disease-free survival (DFS) (HR 0.59; 95% CI, 0.42-0.81) and OS (HR 0.57; 95% CI, 0.43-0.76), as well as a lower cumulative incidence of relapse (HR 0.26; 95% CI, 0.16-0.41). Referral for HSCT was more frequent in the blinatumomab group (RR 1.43; 95% CI, 1.10-1.85). Furthermore, blinatumomab was associated with a higher rate of measurable residual disease (MRD) negativity at the end of the first consolidation cycle (RR 1.96; 95% CI, 1.40-2.76).
CONCLUSION: Blinatumomab improved survival outcomes and increased the proportion of patients referred for HSCT, supporting its role as post-induction consolidation therapy for relapsed B-ALL in paediatric and young adult populations.