Blinatumomab Plus Chemotherapy Improves Survival in Ph-Negative B-ALL

Mark R. Litzow, MD, professor of medicine in the Division of Hematology at the Mayo Clinic, discusses the findings from the ECOG-ACRIN E1910 trial (NCT02003222) which evaluated blinatumomab (Blincyto) added to chemotherapy vs chemotherapy alone in B-cell precursor acute lymphoblastic leukemia (B-ALL).

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0:09 | We found that from the time of the randomization, the 3-year overall survival in the blinatumomab plus chemotherapy patients was 85% compared with 68% for the patients that got chemotherapy. This was a highly significant difference. The P value was 0.002, so this is encouraging for us to see.

0:35 | Amgen, which is the supplier of blinatumomab, took this data to the FDA and got a new indication for blinatumomab. It is already approved for [patients with] relapsed/refractory and MRD-positive [disease], and now, it is approved in the consolidation phase of chemotherapy. The addition of blinatumomab to chemotherapy in this setting has shown improvement in survival and has been a major advance.

1:07 | Now, what we did find in the study was that of the 488 patients that we enrolled at the beginning, only 286 patients made it to the randomization phase. Of those 286, 62 were MRD-positive. We were going to randomize those patients, but when the FDA approved blinatumomab for MRD-positive disease, we no longer randomized them and assigned them. We had 62 of those patients, and then there were 224 MRD-negative patients, 112 in each arm.

1:43 | The point I make here is that if we can move the immunotherapy up earlier in the course of treatment, we hopefully will be able to increase the response rate and lessen the number of patients that we lose from chemotherapy. That is the trend in the field, to move immunotherapeutic agents up earlier in a treatment course. The hope is that eventually we—and we are already starting to see this—can lower the amount of chemotherapy that we give. Whether we would eventually be able to completely eliminate chemotherapy is not known at this time, but it may be a possibility in the future.