FEASIBLE OUTCOME OF BLINATUMOMAB FOLLOWED BY ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION FOR ADULTS WITH RELAPSED OR REFRACTORY PHILADELPHIA-NEGATIVE ACUTE LYMPHOBLASTIC LEUKEMIA
Author(s): ,
Jae-Ho Yoon
Affiliations:
Department of Hematology,Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,Seoul,Korea, Republic Of
,
Seug Yun Yoon
Affiliations:
Division of Hematology & Oncology,Department of Internal Medicine, Soonchunhyang University, College of Medicine, Seoul Hospital,Seoul,Korea, Republic Of;Department of Hematology,Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,Seoul,Korea, Republic Of
,
Joonyeop Lee
Affiliations:
Department of Hematology,Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,Seoul,Korea, Republic Of
,
Changgon Kim
Affiliations:
Division of Hematology & Oncology,Department of Internal Medicine, Soonchunhyang University, College of Medicine, Seoul Hospital,Seoul,Korea, Republic Of
,
Ki-Seong Eom
Affiliations:
Department of Hematology,Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,Seoul,Korea, Republic Of
,
Hee-Je Kim
Affiliations:
Department of Hematology,Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,Seoul,Korea, Republic Of
,
Jong Wook Lee
Affiliations:
Department of Hematology,Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,Seoul,Korea, Republic Of
Seok Lee
Affiliations:
Department of Hematology,Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,Seoul,Korea, Republic Of
EHA Library. Yoon J. Jun 15, 2019; 267256; PS955
Prof. Jae-Ho Yoon
Prof. Jae-Ho Yoon
Contributions
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Abstract

Abstract: PS955

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
In adult patients with relapsed or refractory (R/R) Philadelphia chromosome-negative (Ph-negative) acute lymphoblastic leukemia (ALL), CR rates are much lower and survival outcomes are very poor. For safe salvage and bridge to allogeneic hematopoietic cell transplantation (allo-HCT), several immune-based treatments have been tried. We analyzed the treatment outcomes and prognostic factors of blinatumomab.

Aims
In this study, we analyzed the treatment outcome of blinatumomab and prognostic factors in adult patients with R/R Ph-negative BCP-ALL.

Methods
From 2016 to 2018, 32 adult patients with R/R Ph-negative ALL were treated with blinatumomab. All received uniform prephase dexamethasone 20mg/day for 4 days. Urgent allo-HCT was planned in patients with complete remission (CR). At the time of blinatumomab treatment, 9 patients (28.1%) were primary refractory, 10 (31.2%) had relapsed during/after consolidation chemotherapy, and 13 (40.6%) had relapsed after first (n=11) or second (n=2) allo-HCT.

Results
Overall, 23 patients (71.9%; 100% for primary refractory, 70% for relapsed patients during/after consolidation chemotherapy, 53.8% for relapsed patients after allo-HCT) achieved CR but 3 of them relapsed – thus, 20 (62.5%) finally underwent allo-HCT in CR following blinatumomab. CR rate was lower in poor-risk karyotype (33.3% vs. 87.0% ; p=0.005). After median follow-up of 11.9 months (range 6.7 to 23.6), 1-year OS of all patients was 55.4% with a median survival of 14.5 months. The 1-year OS and relapse rate of 20 patients who underwent allo-HCT was 77.8% and 5.6%, repectively, while 1-year OS for patients who failed to blinatumomab was 12.0% (p<0.001). In addition, extramedullary relapse (EMR, 14.3% vs. 68.4%, p=0.007) and high peripheral blood blast count (26.7% vs. 59.8%; p=0.026) were related with poorer 1-year OS.

Conclusion
Blinatumomab is a feasible choice for salvage chemotherapy for adult patients with R/R Ph-negative ALL which showed a good CR rate at any time of salvage and showed a good bridge to allo-HCT. However, the role in patients with poor-risk karyotype, EMR, or high tumor burden should be evaluated in future trials.

Session topic: 2. Acute lymphoblastic leukemia - Clinical

Keyword(s): Acute lymphoblastic leukemia, Hematopoietic cell transplantation, Refractory

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