Dose-Dense Mini-Hyper-CVD, Inotuzumab Ozogamicin and Blinatumomab Achieves Rapid MRD-Negativity in Philadelphia Chromosome-Negative B-cell Acute Lymphoblastic Leukemia

BACKGROUND

The combination of low-intensity chemotherapy and inotuzumab ozogamicin (INO), with sequential blinatumomab, is highly effective in older adults with newly diagnosed B-cell acute lymphoblastic leukemia (ALL) and in relapsed or refractory B-cell ALL. Earlier, "dose-dense" administration of blinatumomab could lead to earlier and deeper measurable residual disease (MRD) responses and better outcomes.

PATIENTS AND METHODS

We performed a retrospective analysis of the safety and efficacy of a dose-dense regimen of mini-hyper-CVD (mini-hyperfractionated cyclophosphamide, vincristine, and dexamethasone alternating with mini-methotrexate and cytarabine), INO, and blinatumomab in patients with B-cell ALL.

RESULTS

Twenty-one patients were treated (frontline, n = 9; MRD consolidation, n = 4; relapsed/refractory, n = 8). In the frontline cohort, all patients achieved CR/CRi and MRD negativity by flow cytometry at the end of cycle 1. Across the frontline and MRD consolidation cohorts, 10/11 patients (91%) achieved next-generation sequencing MRD negativity at a sensitivity of 10-6, including 6/10 evaluable patients (60%) who achieved next-generation sequencing MRD negativity after cycle 1. The CR/CRi rate in the relapsed/refractory cohort was 63%, and all responders achieved MRD negativity by flow cytometry at the end of cycle 1. The 1-year overall survival rate for the combined cohort of the frontline and MRD-positive patients was 83%. No new safety signals were observed with the dose-dense mini-hyper-CVD, INO, and blinatumomab regimen.

CONCLUSION

Dose-dense delivery of mini-hyper-CVD, INO, and blinatumomab was safe and resulted in rapid and deep MRD negativity in patients with B-cell ALL. This regimen is now being prospectively evaluated in both the frontline and relapsed/refractory settings.

The sharing of eggs by infertile women who are trying to conceive themselves with an egg recipient for financial advantages does not jeopardize the donor's chance of conceiving

PURPOSE

To determine if the sharing of oocytes by an infertile woman with an egg recipient for financial advantages has any negative impact on the success rate for the donor.

METHODS

A matched controlled study was performed comparing pregnancy outcome of women undergoing in vitro fertilization-embryo transfer (IVF-ET) but sharing half of their eggs with a recipient vs women undergoing IVF-ET but not sharing oocytes.

RESULTS

Even though more women sharing oocytes deferred fresh transfer and cryopreserved the embryos because of a greater likelihood of ovarian hyperstimulation syndrome, there was no difference in pregnancy rates between the two groups after their first embryo transfer whether it was with fresh or frozen-thawed embryos.

CONCLUSIONS

Sharing of oocytes by a woman undergoing IVF-ET does not jeopardize her chance of a successful outcome following embryo transfer.

Evaluation of the importance of late follicular phase endometrial echo patterns and pregnancy outcome following embryo transfer by evaluating infertile donor/recipient pairs

PURPOSE

To investigate if the late follicular phase echo pattern is associated with pregnancy outcome in donors vs recipients.

METHODS

Infertile donors sharing eggs with recipients were retrospectively evaluated. The endometrial echo pattern was evaluated on the day of human chorionic gonadotropin injection in donors and on the day before progesterone was given to recipients.

RESULTS

Almost twice as many donors conceived when the triple-line pattern was found compared to isoechogenic (IE) (51.5% or 52/101 vs 27.3% or 6/22) but there were inadequate numbers in the IE group to show a significant difference. There was not even a trend for a difference in recipients (55.2%, 37/67 vs 53.8%, 14/26).

CONCLUSIONS

The trend in this study for higher pregnancy rates in COH cycles with triple-line isoechogenic pattern in the late follicular phase will prompt a study of a larger group of patients undergoing IVF-ET in the modern era. If confirmed one treatment option would be to freeze and defer transfer to an estrogen/progesterone cycle.

A novel method to assess the effect of uterine senescence by comparing pregnancy outcome in younger donors vs older recipients who are sharing a common pool of oocytes

PURPOSE

To evaluate uterine senescence by comparing pregnancy rates in older recipients vs their younger donors who were actually trying to conceive themselves.

METHODS

A retrospective analysis comparing clinical and delivered pregnancy rates in all infertile donors < or = age 35 sharing their eggs with a recipient age > or = 40 over a 6-year time span. These parameters were also evaluated in the first frozen embryo transfer from these couples (if they had one).

RESULTS

The clinical and delivered pregnancy rates were similar in younger donors vs older recipients following fresh embryo transfer. There was a non-significant trend for lower implantation rates in the younger donors. No differences were found when comparing frozen embryo transfers.

CONCLUSIONS

These data support conclusions that the uterus of women > or = 40 does not inhibit embryo implantation.

Effect of the short follicular phase on subsequent conception

The present study was designed to evaluate whether there is a lower pregnancy rate in women with short follicular phases, as defined by attaining the peak estradiol level before day 11 of the cycle. Thirty-two early ovulators with mature follicles were matched with 32 women being treated for similar infertility problems, who ovulated between days 12-20. Pregnancies were achieved by 9 (28.1%) of the early ovulators compared to 19 (59.4%) of the controls. The mean number of cycles required to achieve a pregnancy was 8.6 in the early ovulators compared to 6.4 in the controls. Using the clinical life table method, the 12-month pregnancy rate was estimated to be 31.4% for early ovulators as compared to 66.3% for controls. Whether lengthening the follicular phase by drug treatment will improve pregnancy rates remains to be seen.