Short-course blinatumomab for refractory/relapse precursor B acute lymphoblastic leukemia in children

Background. Despite the successes achieved in the treatment of B-cell acute lymphoblastic leukemia (B-ALL), overcoming the toxicity of standard chemotherapy regimens and the treatment of relapsed/refractory (r/r) forms of the disease remains relevant. The most promising option is to use immunotherapy (IT), including a monoclonal antibody blinatumomab (BM). The purpose of the study. To analyze indications of using, as well as efficacy and tolerability of BM in children with V-ALL. Materials and methods. From April 2016 to January 2024 a retrospective assessment of using of BM in children with B-ALL in the chemotherapy department of oncohematological diseases and TCM for children in Almazov National Medical Research Centre was performed. Results. The study included 53 patients, including 28 (53 %) girls and 25 (47 %) boys with median age of 7,7 (2,08–19,8) years. Indications for using of BM were as follows: (1) consolidation of remission (CR) with primary ALL (n = 17, 32 %); (2) persistence of minimal residual disease (MRD) (n = 23, 43 %) after completion of chemotherapy (CT) induction or before the stage of allogeneic haematopoietic stem cell transplantation (alloHSCT); (3) replacement of the standard CR due to the previous toxicity of СT or other contraindications to its implementation (n = 12, 23 %); (4) salvage therapy for r/r ALL (n = 1, 1,9 %). The status of MRD-negative remission after the 1st course of IT was achieved in 89 % of cases. Therapy using BM in a patient with the r/r ALL and total blast infiltration of the bone marrow was effective and facilitated reducing the tumor population to 7,2% by day 15 of therapy, however, there was a fatal outcome due to development and progression of preexisted severe infection. The most common variants of grade III–IV toxicity were leuko-/neutropenia (28 %) and neurotoxicity (3,7 %). BM dose reduction for the purpose of relieving toxicity was required in 19 % of patients, while the median days of therapy with dose reduction was 4. Corticosteroids were used for this purpose in 11 % of cases, antibacterial therapy — in 13 %. At the time of results evalution, there were no relapses of the disease in the study group. The article analyzes the international experience of using BM in patients with B-ALL.Conclusion. Our experience and the presented literature data demonstrate a reasonable expansion of indications for using of BM in children with B-ALL with high efficacy and satisfactory toxicity profile.

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Bispecific T-Cell Engagers (BiTEs) in Immunotherapy

Sheykhhasan,

La'ah,

Ahmadieh-Yazdi

et al. 2024

Advances in Medical Diagnosis, Treatment, and Care

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Bispecific T-cell engagers (BiTEs) is a novel subclass of T-cell-engaging bispecific antibodies (bulbs) that are promising for the treatment of cancer. BiTEs direct cytotoxic T-cell activity towards malignant cells, resulting in targeted destruction of tumor cells. This chapter provides an overview of the current landscape of BiTE therapy, highlighting its efficacy in hematologic malignancies such as B-cell acute lymphoblastic leukemia (B-ALL) and exploring its potential applications in solid tumors. Additionally, challenges such as immunogenicity, stability, and off-target effects were discussed, alongside ongoing efforts to overcome these obstacles through protein engineering and combination therapies. Future directions in BiTE therapy include optimizing of delivery methods and exploring novel combination strategies. Overall, BiTE therapy represents a promising approach to cancer treatment, with the potential to revolutionize immunotherapy and improve patient outcomes.

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Short-course blinatumomab for refractory/relapse precursor B acute lymphoblastic leukemia in children

Cited by 3 publications

References 39 publications

Blinatumomab for the treatment of acute lymphoblastic leukemia in a real-world setting: clinical vignettes

Blinatumomab for the treatment of acute lymphoblastic leukemia in a real-world setting: clinical vignettes

Blinatumomab in pediatric acute lymphoblastic leukemia: one center experience

Bispecific T-Cell Engagers (BiTEs) in Immunotherapy

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