Efficacy and safety of blinatumomab for the treatment of patients relapsing after allogeneic hematopoietic cell transplantation: a systemic review and meta-analysis

Objective: We aim to evaluate the efficacy and safety of blinatumomab for the treatment of post-transplant relapse patients with acute lymphoblastic leukemia (ALL).

Methods: The search was conducted using several databases including the PubMed, Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI) and Wanfang Data Knowledge Service Platform to collect clinical studies related to blinatumomab. The primary outcome measures were complete remission (CR), 1-year overall survival (OS), 2-year OS, median OS and adverse events (AEs). Grade ≥3 AEs were mainly analyzed for safety, including anemia, thrombocytopenia, neutropenia, encephalopathy, peripheral paresthesia, tremor and cytokine release syndrome (CRS).

Results: A total of 7 studies, involving a total of 292 patients were included in the analysis. The analysis results showed CR rate of 48%, 1-year OS rate of 40% 2-year OS rate of 21%, median OS 7.47. For safety analysis, the incidence of grade ≥3 AEs, including the incidence of grade ≥3 anemic toxicity was 13% , the incidence of grade ≥3 thrombocytopenia toxicity was 7% , the incidence of grade ≥3 neutropenia toxicity 24%, the incidence of grade ≥3 encephalopathic toxicity was 4% , the incidence of grade ≥3 peripheral paresthesia toxicity 4%, the incidence of grade ≥3 tremor toxicity 8% , the incidence of grade ≥3 CRS toxicity was 4%.

Conclusion: Blinatumomab may be a safe and an effective treatment approach for post-transplant relapse patients with ALL, but its long-term efficacy is still a big challenge. In regard to Regarding AEs, serious CRS and neurological events were infrequent and manageable.