Blinatumomab compared with standard of care for the treatment of adult patients with relapsed/refractory Philadelphia chromosome-positive B-precursor acute lymphoblastic leukemia.

Abstract

BACKGROUND:

A single-arm, phase 2 trial demonstrated the efficacy and safety of blinatumomab, a bispecific T-cell-engaging antibody construct, in patients with relapsed/refractory (r/r) Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL), a rare hematologic malignancy with limited treatment options. This study compared outcomes with blinatumomab with those of a historical control treated with the standard of care (SOC).

METHODS:

The blinatumomab trial enrolled adult patients with Ph+ ALL who were r/r to at least 1 second-generation tyrosine kinase inhibitor (n = 45). Propensity score analysis (PSA) was used to compare outcomes with blinatumomab with those of an external cohort of similar patients receiving SOC chemotherapy (n = 55). The PSA mitigated confounding variables between studies by adjusting for imbalances in the age at diagnosis and start of treatment, sex, duration from diagnosis to most recent treatment, prior allogeneic hematopoietic stem cell transplantation, prior salvage therapy, and number of salvage therapies. Bayesian data augmentation was applied to improve power to 80% with data from a phase 3 blinatumomab study in r/r Philadelphia chromosome-negative ALL.

RESULTS:

In the PSA, the rate of complete remission or complete remission with partial hematologic recovery was 36% for blinatumomab and 25% for SOC, and this resulted in an odds ratio of 1.54 (95% confidence interval [CI], 0.61-3.89) or 1.70 (95% credible interval [CrI], 0.94-2.94) with Bayesian data augmentation. Overall survival favored blinatumomab over SOC, with a hazard ratio of 0.81 (95% CI, 0.57-1.14) or 0.77 (95% CrI, 0.61-0.96) with Bayesian data augmentation.

CONCLUSIONS:

These results further support blinatumomab as a treatment option for patients with r/r Ph+ ALL.

• Authors: Alessandro Rambaldi, Josep-Maria Ribera, Hagop M Kantarjian, Hervé Dombret, Oliver G Ottmann, Anthony S Stein, Catherine A Tuglus, Xiaoyue Zhao, Christopher Kim, Giovanni Martinelli
• Journal: Cancer (Cancer) Vol. 126 Issue 2 Pg. 304-310 (01 15 2020) ISSN: 1097-0142 [Electronic] United States
• PMID: 31626339 (Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Chemical References

• Antibodies, Bispecific
• blinatumomab

Topics

• Adolescent
• Adult
• Antibodies, Bispecific (pharmacology, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (pharmacology, therapeutic use)
• Drug Resistance, Neoplasm
• Female
• Follow-Up Studies
• Hematopoietic Stem Cell Transplantation
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy, genetics, mortality, pathology)
• Philadelphia Chromosome
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (genetics, mortality, pathology, therapy)
• Propensity Score
• Salvage Therapy (methods)
• Standard of Care
• Transplantation, Homologous
• Treatment Outcome
• Young Adult