Wang Yi-Lun, Chang Tsung-Yen, Wen Yu-Chuan, Yang Shu-Ho, Hsiao Yi-Wen, Chiu Chia-Chi, Chen Yu-Chieh, Hu Ruei-Shan, Chen Shih-Hsiang, Jaing Tang-Her, Hsiao Chih-Cheng
Department of Pediatrics, Division of Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan 33315, Taiwan.
Department of Nursing, Chang Gung Memorial Hospital, Taoyuan 33315, Taiwan.
Hematol Rep. 2024 Jun 3;16(2):347-353. doi: 10.3390/hematolrep16020035.
Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains an unresolved matter of concern regarding adverse outcomes. This case study aimed to evaluate the effectiveness of blinatumomab, with or without door lymphocyte infusion (DLI), in treating measurable residual disease (MRD)-positive B-ALL. All patients who received blinatumomab salvage therapy were included in this study. Eleven patients were included in the study. All patients were evaluated for MRD-negativity. Before starting blinatumomab therapy, seven patients tested positive for MRD, three tested negative, and one had refractory disease. Hematopoietic cell transplantation (HCT) was reserved for five patients with persistent MRD. Six patients became MRD-negative and subsequent HCT was not performed. Only two patients relapsed; one patient died of relapse, and the other one received carfilzomib-based therapy and was MRD-negative thereafter. Nine patients were MRD-negative at a median follow-up of 28 months (15-52 months). Two of three MRD-positive post-transplant patients remained in complete molecular remission after preemptive DLI at the last follow-up date. In the first salvage, blinatumomab may achieve complete remission and bridging to HCT in pediatric patients with end-of-induction MRD-positive B-cell precursor ALL. The decision on how to treat post-transplant relapse continues to affect survival outcomes. Blinatumomab combined with DLI may extend the armamentarium of release options for high-risk pediatric patients. This approach is encouraging for high-risk ALL patients who are MRD-positive post-transplantation.
复发性B细胞急性淋巴细胞白血病（B-ALL）仍然是一个关于不良预后的未解决问题。本病例研究旨在评估博纳吐单抗联合或不联合供者淋巴细胞输注（DLI）治疗微小残留病（MRD）阳性B-ALL的有效性。所有接受博纳吐单抗挽救治疗的患者均纳入本研究。本研究共纳入11例患者。所有患者均评估MRD转阴情况。在开始博纳吐单抗治疗前，7例患者MRD检测呈阳性，3例呈阴性，1例为难治性疾病。5例MRD持续阳性的患者接受了造血细胞移植（HCT）。6例患者MRD转阴，随后未进行HCT。仅2例患者复发；1例患者死于复发，另1例接受了基于卡非佐米的治疗，此后MRD转阴。9例患者在中位随访28个月（15 - 52个月）时MRD转阴。3例移植后MRD阳性患者中有2例在最后随访日期经抢先性DLI后仍处于完全分子缓解状态。在首次挽救治疗中，博纳吐单抗可能使诱导期末MRD阳性的B细胞前体ALL儿科患者实现完全缓解并过渡到HCT。如何治疗移植后复发的决策继续影响生存结果。博纳吐单抗联合DLI可能会扩展高危儿科患者的缓解选择手段。这种方法对于移植后MRD阳性的高危ALL患者是令人鼓舞的。
