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Fracchiolla NS, Sciumè M, Papayannidis C, Vitale A, Chiaretti S, Annunziata M, Giglio F, Salutari P, Forghieri F, Lazzarotto D, Lunghi M, Imovilli A, Scappini B, Bonifacio M, Dargenio M, Gurrieri C, Todisco E, Defina M, Del Principe MI, Zappasodi P, Cerrano M, Santoro L, Tagliaferri E, Barozzi E, De Roberto P, Canzi M, Buzzatti E, Sartor C, Passamonti F, Foà R, Curti A. Blinatumomab and Inotuzumab Ozogamicin Sequential Use for the Treatment of Relapsed/Refractory Acute Lymphoblastic Leukemia: A Real-Life Campus All Study. Cancers (Basel) 2023; 15:4623. [PMID: 37760592 PMCID: PMC10526797 DOI: 10.3390/cancers15184623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Blinatumomab (Blina) and inotuzumab ozogamicin (InO) has improved the outcome of relapsed/refractory B-lymphoblastic leukemia (R/R B-ALL). However, little is known about the outcome after recurrence and re-treatment with immunotherapy. METHODS We describe 71 R/R B-ALL patients treated for different relapses with Blina and InO. Blina was the first treatment in 57 patients and InO in 14. Twenty-seven patients had a previous allogeneic hematopoietic stem cell transplantation (allo-HSCT). RESULTS In the Blina/InO group, after Blina, 36 patients (63%) achieved a complete remission (CR), with 42% of negative minimal residual disease (MRD-); after InO, a CR was achieved in 47 patients (82%, 34 MRD-). In the InO/Blina group, after InO, 13 cases (93%) reached a CR (6 MRD-); after Blina, a CR was re-achieved in 6 cases (43%, 3 MRD-). Twenty-six patients proceeded to allo-HSCT. In the Blina/InO group, the median overall survival (OS) was 19 months; the disease-free survival (DFS) after Blina was 7.4 months (11.6 vs. 2.7 months in MRD- vs. MRD+, p = 0.03) and after InO, 5.4 months. In the InO/Blina group, the median OS was 9.4 months; the median DFS after InO was 5.1 months and 1.5 months after Blina (8.7 vs. 2.5 months in MRD- vs. MRD+, p = 0.02). With a median follow-up of 16.5 months from the start of immunotherapy, 24 patients (34%) are alive and 16 (22%) are alive in CR. CONCLUSION In our series of R/R B-ALL, Blina and InO treatment demonstrate efficacy for subsequent relapses in terms of MRD response, OS and DFS, and as a bridge to allo-HSCT.
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Affiliation(s)
- Nicola Stefano Fracchiolla
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (E.T.); (P.D.R.); (M.C.); (F.P.)
| | - Mariarita Sciumè
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (E.T.); (P.D.R.); (M.C.); (F.P.)
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “L. & A. Seràgnoli”, 40138 Bologna, Italy; (C.P.); (C.S.); (A.C.)
| | - Antonella Vitale
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy; (A.V.); (S.C.); (R.F.)
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy; (A.V.); (S.C.); (R.F.)
| | - Mario Annunziata
- Hematology Unit, Azienda Ospedaliera Cardarelli, 11411 Naples, Italy;
| | - Fabio Giglio
- Division of Onco-Hematology, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Prassede Salutari
- Hematology Unit, Ospedale Civile Santo Spirito, 65100 Pescara, Italy;
| | - Fabio Forghieri
- Department of Medical and Surgical Sciences, Section of Hematology, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Davide Lazzarotto
- Division of Hematology, University Hospital-ASUFC, 33100 Udine, Italy;
| | - Monia Lunghi
- Division of Hematology, Department of Translational Medicine, AOU Maggiore della Carità, Università del Piemonte Orientale, 13100 Novara, Italy;
| | - Annalisa Imovilli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, 42123 Reggio Emilia, Italy;
| | - Barbara Scappini
- Hematology Unit, Department of Experimental and Clinical Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, 50121 Florence, Italy;
| | - Massimiliano Bonifacio
- Department of Medicine, Section of Hematology, University of Verona, 37129 Verona, Italy;
| | - Michelina Dargenio
- Hematology and Stem Cell Transplantation Unit, Vito Fazzi Hospital, 73100 Lecce, Italy;
| | - Carmela Gurrieri
- Dipartimento Strutturale Aziendale Medicina, University of Padova, 35122 Padua, Italy;
| | - Elisabetta Todisco
- Ospedale di Busto Arsizio, ASST Valle Olona, 21052 Busto Arsizio, Italy;
| | - Marzia Defina
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Maria Ilaria Del Principe
- Hematology Unit, Department of Biomedicina and Prevention, Tor Vergata University, 00133 Rome, Italy; (M.I.D.P.); (E.B.)
| | - Patrizia Zappasodi
- Department of Hematology Oncology, Division of Hematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Marco Cerrano
- Division of Hematology, A.O.U. Città della Salute e della Scienza, 10126 Turin, Italy;
| | - Lidia Santoro
- Struttura Complessa di Ematologia e Trapianto Emopoietico, A.O.S.G. Moscati, 83100 Avellino, Italy;
| | - Elena Tagliaferri
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (E.T.); (P.D.R.); (M.C.); (F.P.)
| | - Enrico Barozzi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Pasquale De Roberto
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (E.T.); (P.D.R.); (M.C.); (F.P.)
| | - Marta Canzi
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (E.T.); (P.D.R.); (M.C.); (F.P.)
| | - Elisa Buzzatti
- Hematology Unit, Department of Biomedicina and Prevention, Tor Vergata University, 00133 Rome, Italy; (M.I.D.P.); (E.B.)
| | - Chiara Sartor
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “L. & A. Seràgnoli”, 40138 Bologna, Italy; (C.P.); (C.S.); (A.C.)
| | - Francesco Passamonti
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.S.); (E.T.); (P.D.R.); (M.C.); (F.P.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy; (A.V.); (S.C.); (R.F.)
| | - Antonio Curti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “L. & A. Seràgnoli”, 40138 Bologna, Italy; (C.P.); (C.S.); (A.C.)
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Badar T, Szabo A, Dinner S, Liedtke M, Burkart M, Shallis RM, Yurkiewicz IR, Kuo E, Khan MA, Balasubramanian S, Yang J, Hefazi M, Podoltsev N, Patel A, Curran E, Wang A, Arslan S, Aldoss I, Siebenaller C, Mattison RJ, Litzow MR, Wadleigh M, Advani AS, Atallah E. Sequencing of novel agents in relapsed/refractory B-cell acute lymphoblastic leukemia: Blinatumomab and inotuzumab ozogamicin may have comparable efficacy as first or second novel agent therapy in relapsed/refractory acute lymphoblastic leukemia. Cancer 2020; 127:1039-1048. [PMID: 33259056 DOI: 10.1002/cncr.33340] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/25/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND The availability of novel agents (NAs), including blinatumomab and inotuzumab ozogamicin (InO), has improved the outcomes of patients with relapsed/refractory (RR) B-cell acute lymphoblastic leukemia (ALL). Because of the relative effectiveness, it is often a challenge for clinicians to determine how to best sequence these NAs with respect to efficacy and toxicity. METHODS In this multicenter, retrospective study of patients with RR ALL treated with blinatumomab, InO, or both, their efficacy as a first or second NA was compared. RESULTS Among 276 patients, 221 and 55 received blinatumomab and InO, respectively, as a first NA therapy. The complete remission (CR)/complete remission with incomplete count recovery (CRi) rate was 65% and 67% for the blinatumomab and InO groups, respectively (P = .73). The rate of treatment discontinuation due to adverse events was 4% and 7% in the blinatumomab and InO groups, respectively. Ninety-two patients (43%) in the blinatumomab group and 13 patients (29%) in the InO group proceeded with allogeneic hematopoietic stem cell transplantation. The median overall survival (OS) was 15 and 11.6 months in the blinatumomab and InO groups, respectively. A subset analysis was performed for 61 patients who received both NAs (blinatumomab and then InO [n = 40] or InO and then blinatumomab [n = 21]). The CR/CRi rate was 58% for patients who received InO as the second NA and 52% for patients who received blinatumomab as the second NA. The median OS was 10.5 for patients who received InO as the second NA and 5.9 months for patients who received blinatumomab as the second NA (P = .09). CONCLUSIONS Although the limited power of this study to detect a significant difference between subgroups is acknowledged, the data suggest that blinatumomab and InO may have comparable efficacy as a first or second NA therapy in RR ALL.
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Affiliation(s)
- Talha Badar
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, Illinois
| | | | - Madelyn Burkart
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Hospital, Chicago, Illinois
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Eric Kuo
- Stanford University Cancer Center, Stanford, California
| | - Muhammad Ali Khan
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jay Yang
- Karmanos Cancer Institute, Detroit, Michigan
| | - Mehrdad Hefazi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Nikolai Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Anand Patel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Emily Curran
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy Wang
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Shukaib Arslan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Ibrahim Aldoss
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Caitlin Siebenaller
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J Mattison
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anjali S Advani
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ehab Atallah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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