Acute Lymphoblastic Leukemia ⎼ Posters and

Transcript:Acute Lymphoblastic Leukemia ⎼ Posters and:
Acute Lymphoblastic Leukemia ⎼ Posters and Abstracts from San Diego 60th ASH Annual Meeting & Exposition Blinatumomab for Minimal Residual Disease in Adults with B-Cell Precursor Acute Lymphoblastic Leukemia BLAST Study Follow-Up Gökbuget N, et al. ASH 2018. Abstr 554. BLAST Study Design1 and Follow-Up2 Open-label, single-arm phase 2 study Pts (N=116, age ≥18 years with BCP-ALL in first or later hematologic CR and with persistent or recurrent MRD≥10-3 after a minimum of 3 cycles of intensive chemotherapy) received blinatumomab 15 μg/m2/d by continuous IV infusion for up to 4 cycles (each cycle: 4 weeks of blinatumomab infusion → 2 weeks, treatment-free). MRD evaluation: real-time qPCR performed mostly in the central reference laboratory or in national reference laboratories. The primary endpoint: the rate of complete MRD response after blinatumomab cycle 1 The current update (minimum F/U = 3 years; median F/U = 53.1 months after blinatumomab treatment) reports long-term OS in 110 pts with Ph- BCP-ALL and <5% blasts at enrollment, including 74 who received allo-SCT while in continuous CR after blinatumomab treatment. 1. Gökbuget N, et al. Blood. 2018;131:1522-1531. 2. Gökbuget N, et al. ASH 2018. Abstr 554. BLAST Study Follow-Up Overall Survival Median OS = 36.5 months (reached a plateau) Complete MRD responders (n=85) = NR (95% CI: 27.3 months to NR) Underwent allo-SCT in continuous CR (n=61) = NR (95% CI: 25.7 months to NR) MRD+ in CR1 (n=60) = NR (95% CI: 29.5 months to NR) MRD non-responders (n=22) = 12.5 months (95% CI: 3.2 to 39.7) Underwent allo-SCT in continuous CR (n=10) = 16.1 months (95% CI: (1.1 to NR) MRD+ in CR1 (n=13) = 10.6 months (95% CI: 2.7 to 39.7) Gökbuget N, et al. ASH 2018. Abstr 554. BLAST Study Follow-Up Summary and Faculty Takeaways This update further demonstrates the long-term OS benefits of blinatumomab treatment in adults with MRD+ BCP-ALL. The MRD+ is a sign of disease refractoriness, not just a biomarker, and pts who are MRD+ have a very poor outcome. We should not transplant pts while they are MRD+, we should make every effort to attain MRD- status, and blinatumomab is highly effective in this regard. In practice, check for MRD+, whether due to a persistent disease or relapse, give them blinatumomab and, then, if MRD-, go for transplant. Down the road, the role of transplant may become questionable; do we go for transplant or not? I would say, today,