Cleveland Clinic Florida, Weston, Florida, United States.
Florida Cancer Specialists & Research Institute LLC, Fort Myers, Florida, United States.
J Oncol Pharm Pract. 2022 Jul;28(5):1269-1275. doi: 10.1177/10781552211073958. Epub 2022 Jan 19.
Acute Lymphoblastic Leukemia (ALL) is an aggressive cancer that requires intense chemotherapy and has a high rate of recurrence. Treatments of Relapse/Refractory (R/R) B-cell ALL are limited. Blinatumomab, a bispecific T-cell engager (CD19/CD3) monocolonal antibody, and Inotuzumab Ozogamicin, an anti-CD22 antibody conjugate, are current recommended options.
To describe a R/R B-cell ALL patient who failed blinatumomab therapy. Subsequently she received inotuzumab ozogamicin achieving a complete response.
MANAGEMENT & OUTCOME: Our patient was initially treated with CALGB 10403 regimen but did not achieve a complete response. Blinatumomab was given for relapse/refractory disease however she had an incomplete response despite having 100% expression in CD19 markers. Consequently, she received inotuzumab ozogamicin attributable to 70% expression of CD22. She responded with a complete response and transitioned to a successful hematopoietic stem cell transplant.
There is limited clinical guidance on the preferred treatment of adult R/R B-Cell ALL. Currently, there are no randomized head-to-head trials comparing efficacy of blinatumomab and inotuzumab ozogamicin. Clinical patterns of blinatumomab resistance has been reported. Our case study remains unclear of why our patient had unsuccessful outcomes with blinatumomab regardless of having CD19 positivity of 100%. Future prospective analysis and comparative studies are needed to determine proper sequencing of these therapies.
急性淋巴细胞白血病（ALL）是一种侵袭性癌症，需要强烈的化疗，且复发率很高。复发/难治性（R/R）B 细胞 ALL 的治疗方法有限。blinatumomab 是一种双特异性 T 细胞衔接器（CD19/CD3）单克隆抗体，以及 inotuzumab ozogamicin，一种抗 CD22 抗体偶联物，是目前推荐的选择。
描述一位 R/R B 细胞 ALL 患者，其blinatumomab 治疗失败。随后，她接受了 inotuzumab ozogamicin 治疗，达到完全缓解。
我们的患者最初接受了 CALGB 10403 方案治疗，但未达到完全缓解。blinatumomab 用于复发/难治性疾病，但尽管 CD19 标志物表达 100%，她仍未完全缓解。因此，她接受了 inotuzumab ozogamicin 治疗，因为 CD22 表达 70%。她的反应为完全缓解，并成功过渡到造血干细胞移植。
成人 R/R B 细胞 ALL 的首选治疗方法临床指导有限。目前，尚无比较 blinatumomab 和 inotuzumab ozogamicin 疗效的随机头对头试验。已经报道了 blinatumomab 耐药的临床模式。我们的病例研究仍不清楚为什么尽管我们的患者 CD19 阳性率为 100%，但仍对 blinatumomab 治疗无反应。需要进行未来的前瞻性分析和比较研究，以确定这些治疗方法的适当顺序。
