Kantarjian Hagop M, Zugmaier Gerhard, Brüggemann Monika, Wood Brent L, Horst Heinz A, Zeng Yi, Martinelli Giovanni
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Amgen Research (Munich) GmbH, Staffelseestraße 2, 81477 Munich, Germany.
Cancers (Basel). 2021 Nov 9;13(22):5607. doi: 10.3390/cancers13225607.
Association of blinatumomab treatment with myelosuppression was examined in this study. Peripheral blood counts were assessed prior to, during, and after blinatumomab treatment in patients with relapsed/refractory Philadelphia chromosome-negative (Ph-) B-cell precursor (BCP) acute lymphoblastic leukemia (ALL; = 267) and Ph+ BCP-ALL ( = 45) from the TOWER and ALCANTARA studies, respectively, or chemotherapy in patients with Ph- BCP-ALL ( = 109) from the TOWER study; all the patients with relapsed/refractory BCP-ALL and responders achieving complete remission (CR) or CR with partial/incomplete hematological recovery (CRh/CRi) were evaluated. Event-free survival (EFS) and overall survival (OS) were assessed in patients achieving CR and CRh/CRi. Median leukocyte, neutrophil, and platelet counts increased during two blinatumomab cycles but remained low longer after chemotherapy. Among the responders, there was a trend that a greater proportion of patients achieved CR with blinatumomab (Ph-, 76.5%; Ph+, 77.8%) versus with chemotherapy (Ph-, 63.6%). In the TOWER study, the survival prognosis for patients achieving CRh/CRi versus CR with blinatumomab was more similar (median OS, 11.9 (95% CI, 3.9-not estimable (NE)) vs. 15.0 (95% CI, 10.4-NE) months, = 0.062) than with chemotherapy (5.2 (95% CI, 1.6-NE) vs. 18.9 (95% CI, 9.3-NE) months, = 0.013). Blinatumomab treatment, with only temporary and transient myelosuppression, resulted in a greater survival benefit than chemotherapy.
本研究考察了博纳吐单抗治疗与骨髓抑制的相关性。分别在TOWER和ALCANTARA研究中，对复发/难治性费城染色体阴性（Ph-）B细胞前体（BCP）急性淋巴细胞白血病（ALL；n = 267）和Ph+B-ALL（n = 45）患者接受博纳吐单抗治疗前、治疗期间和治疗后的外周血细胞计数进行评估，或在TOWER研究中对Ph-BCP-ALL患者（n = 109）进行化疗；对所有复发/难治性BCP-ALL患者以及达到完全缓解（CR）或伴有部分/不完全血液学恢复的CR（CRh/CRi）的缓解者进行评估。对达到CR和CRh/CRi的患者评估无进展生存期（EFS）和总生存期（OS）。在两个博纳吐单抗疗程期间，白细胞、中性粒细胞和血小板计数中位数增加，但化疗后保持较低水平的时间更长。在缓解者中，有一个趋势是，与化疗相比，接受博纳吐单抗治疗达到CR的患者比例更高（Ph-，76.5%；Ph+，77.8%）（Ph-，63.6%）。在TOWER研究中，与化疗相比，接受博纳吐单抗治疗达到CRh/CRi的患者与达到CR的患者的生存预后更相似（中位OS，11.9（95%CI，3.9-不可估计（NE））个月vs.15.（95%CI，10.4-NE）个月，P = 0.062）（5.2（95%CI，1.6-NE）个月vs.18.9（95%CI，9.3-NE）个月，P = 0.013）。博纳吐单抗治疗仅导致暂时和短暂的骨髓抑制，比化疗带来更大的生存获益。
