Abstract
Outcomes of acute lymphoblastic leukemia (ALL) in older adults treated with chemotherapy are poor. The CD19/CD3 bispecific T-cell engager (BiTE) antibody blinatumomab is approved for refractory, relapsed or minimal/measurable residual disease (MRD)-positive B-cell ALL, but there is little experience in the upfront setting, including in older patients. We retrospectively analyzed outcomes of blinatumomab monotherapy in five newly diagnosed Philadelphia chromosome-negative B-cell ALL patients over 70 years. Three had cytokine release syndrome, treated with dexamethasone and/or tocilizumab, and four patients had neurotoxicity, treated with dexamethasone, without blinatumomab interruption. All five achieved complete remission (CR) after cycle one, three with undetectable MRD. All five were alive at 8 to 15 months. Three remained in MRD-negative CR. Two relapsed after cycle 3, one with extramedullary disease. In our small cohort of patients over 70 years, blinatumomab was safe initial therapy and produced a high response rate.
Highlights
Despite recent advances, outcomes in older adults with newly diagnosed acute lymphoblastic leukemia (ALL) remain poor, with higher early mortality, lower complete remission (CR) rates, higher relapse rates and shorter survival than younger patients [1]
Blinatumomab is a CD19/CD3 bispecific T-cell engager (BiTE) antibody that is currently approved by the United States Food and Drug Administration (FDA) and the European Medical Agency (EMA) for use in adults and children with refractory or relapsed B-cell ALL or with B-ALL in first or second CR with minimal/measurable residual disease (MRD) detected as 0.1% or greater [5,6,7]
All five patients had CD22 expression with three of five patients having over 90% CD22 expression on lymphoblasts while two patients had between 50 and 70% CD22 expression
Summary
Outcomes in older adults with newly diagnosed acute lymphoblastic leukemia (ALL) remain poor, with higher early mortality, lower complete remission (CR) rates, higher relapse rates and shorter survival than younger patients [1]. Reasons include both the poor tolerance of intensive chemotherapy and the higher incidence of leukemia-related poor-risk features, such as adverse karyotype, with increasing age, so that intensive therapies, even if tolerated, are less likely to be effective [1]. There is a lack of effective therapeutic options, and of evidence-based guidelines for treatment of ALL in patients 70 years of age and older. We report five patients over age 70 years receiving single-agent blinatumomab as initial therapy for Ph-negative B-ALL
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