Dr Bhatnagar on AlloSCT Outcomes After Blinatumomab/Chemo in MRD-Negative B-ALL

"The purpose of this particular abstract was to determine whether [patients with] MRD negative B-ALL benefited from [allogeneic stem cell transplant]…Essentially, there were no significant differences [observed] in relapse-free survival or overall survival [between the] arms."

Bhavana "Tina" Bhatnagar, DO, associate professor, director of Hematology and Medical Oncology, West Virginia University Cancer Institute at Wheeling Hospital, provides an update on the outcomes of allogeneic stem cell transplantation (alloSCT) in patients with newly diagnosed, BCR::ABL-negative, measurable residual disease (MRD)–negative B-lineage acute lymphoblastic leukemia (B-ALL) who were treated with blinatumomab (Blincyto) plus chemotherapy or chemotherapy plus placebo during the phase 3 ECOG-ACRIN E1910 study (NCT02003222).

Data presented at the 2024 ASH Annual Meeting demonstrated that among MRD-negative patients randomly assigned to conventional chemotherapy alone or chemotherapy plus blinatumomab, the addition of blinatumomab to consolidation chemotherapy did not produce significant differences in relapse-free survival (RFS) or overall survival (OS) following alloSCT. Among patients who underwent alloSCT, the 3-year RFS rate was 82% for those treated with blinatumomab plus chemotherapy (n = 22) vs 67% for those given chemotherapy alone (n = 22; HR, 0.52; 95% CI, 0.15-1.79). The 3-year OS rates were 82% and 72%, respectively (HR, 0.59; 95% CI, 0.12-2.11).

Previous data from ECOG-ACRIN E1910 trial supported the June 2024 FDA approval of blinatumomab for the treatment of adult and pediatric patients aged 1 month or older who have CD19-positive, Philadelphia chromosome–negative, B-ALL in the consolidation phase, irrespective of MRD status. This subgroup analysis aimed to explore whether alloSCT offers further benefit for patients achieving MRD negativity, Bhatnagar explains.

Findings highlighted that MRD negativity itself is associated with favorable outcomes, potentially reducing the reliance on allogeneic SCT in this population, she says. Achieving MRD negativity through blinatumomab may allow patients to avoid the risks and toxicities associated with transplantation, particularly in a population where treatment-related morbidity can be significant, she continues.

Bhatnagar notes that this analysis was limited by a small sample size; however results may also be attributed to biologic differences in the older adult population, she concludes.