Effect of Postreinduction Therapy Consolidation With Blinatumomab vs Chemotherapy on Disease-Free Survival in Children, Adolescents, and Young Adults With First Relapse of B-Cell Acute Lymphoblastic Leukemia: A Randomized Clinical Trial
RCT (n=208) did not find a statistically significant improvement in disease free survival for 2 cycles of blinatumomab vs chemotherapy prior to transplant (54.4% vs 39.0%, HR 0.70, 95%CI 0.47-1.03), though 2 year overall survival was superior (71.3% vs 58.4%, 0.62, 0.39-0.98).
Source:
Journal of the American Medical Association
SPS commentary:
A related study in high risk paediatric patients with high-risk first-relapse b-cell acute lymphoblastic leukaemia found blinatumomab was superior to chemotherapy for the third consolidation therapy prior to allogeneic hematopoietic stem cell transplant for event free survival (incidence of events in 31% vs. 57%, respectively, HR 0.33, 95%CI 0.18-0.61).
A related commentary discusses these studies. It concludes that they represent the first randomised trials to show a clear benefit of blinatumomab for children with high-risk relapsed B-ALL. The improved outcomes, coupled with a favourable toxicity profile, support investigating the inclusion of blinatumomab and other immunotherapies in future clinical trials of frontline treatment and therapy for relapse among patients with childhood ALL.