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"The purpose of this particular abstract was to determine whether [patients with] MRD negative B-ALL benefited from [allogeneic stem cell transplant]…Essentially, there were no significant differences [observed] in relapse-free survival or overall survival [between the] arms."

Bhavana "Tina" Bhatnagar, DO, associate professor, director of Hematology and Medical Oncology, West Virginia University Cancer Institute at Wheeling Hospital, provides an update on the outcomes of allogeneic stem cell transplantation (alloSCT) in patients with newly diagnosed, 

-negative, measurable residual disease (MRD)–negative B-lineage acute lymphoblastic leukemia (B-ALL) who were treated with blinatumomab (Blincyto) plus chemotherapy or chemotherapy plus placebo during the phase 3 ECOG-ACRIN E1910 study (NCT02003222).

 demonstrated that among MRD-negative patients randomly assigned to conventional chemotherapy alone or chemotherapy plus blinatumomab, the addition of blinatumomab to consolidation chemotherapy did not produce significant differences in relapse-free survival (RFS) or overall survival (OS) following alloSCT. Among patients who underwent alloSCT, the 3-year RFS rate was 82% for those treated with blinatumomab plus chemotherapy (n = 22) vs 67% for those given chemotherapy alone (n = 22; HR, 0.52; 95% CI, 0.15-1.79). The 3-year OS rates were 82% and 72%, respectively (HR, 0.59; 95% CI, 0.12-2.11).

Previous data from ECOG-ACRIN E1910 trial supported 

the June 2024 FDA approval of blinatumomab

 for the treatment of adult and pediatric patients aged 1 month or older who have CD19-positive, Philadelphia chromosome–negative, B-ALL in the consolidation phase, irrespective of MRD status. This subgroup analysis aimed to explore whether alloSCT offers further benefit for patients achieving MRD negativity, Bhatnagar explains.

Findings highlighted that MRD negativity itself is associated with favorable outcomes, potentially reducing the reliance on allogeneic SCT in this population, she says. Achieving MRD negativity through blinatumomab may allow patients to avoid the risks and toxicities associated with transplantation, particularly in a population where treatment-related morbidity can be significant, she continues.

Bhatnagar notes that this analysis was limited by a small sample size; however results may also be attributed to biologic differences in the older adult population, she concludes.

Videos

Bhavana Bhatnagar, DO, discusses outcomes for allogeneic stem cell transplantation after blinatumomab plus chemotherapy in B-ALL.

Dr Bhatnagar on AlloSCT Outcomes After Blinatumomab/Chemo in MRD-Negative B-ALL

Bhavana “Tina” Bhatnagar, DO, assistant professor, Department of Medicine, West Virginia University; associate professor, Section of Hematology/Oncology, director, Hematology and Medical Oncology, West Virginia University Cancer Institute, discusses the investigation of minimal residual disease (MRD) negativity in patients with acute myeloid leukemia (AML).

Dr Bhatnagar on MRD Negativity in Post-Transplant AML

Although the role of MRD negativity is well defined in acute lymphoblastic leukemia, where small amounts of residual disease can predict for worse survival outcomes, in AML, the role of MRD negativity is less clear, Bhatnagar says. In AML, MRD negativity is associated with improved survival outcomes, Bhatnagar explains. However, questions remain regarding the definition of MRD negativity in this disease, as well as what assays should be used and what the sensitivity of those assays should be, Bhatnagar emphasizes.

MRD negativity by flow cytometry or next-generation sequencing that shows no recurrence of the mutations patients had at diagnosis is predictive of improved post-transplant responses, according to Bhatnagar. The goal of AML treatments is to achieve as much disease control as possible to improve patient outcomes, Bhatnagar notes.

Although trials investigating uproleselan (GMI-1271) in patients with AML have used multiparameter flow cytometry to detect MRD, the accuracy of this assessment depends on the sensitivity of the assay and its ability to detect small amounts of leukemic cells, Bhatnagar says. AML remains difficult to cure because AML cells are proliferative, and their locations can vary, Bhatnagar explains.

Dr Bhatnagar on MRD Negativity as an End Point in AML Clinical Trials

Clinical trials that use MRD negativity as an end point can inform patients with AML who are interested in learning about the benefits of MRD negativity and knowing the MRD levels that predict relapse and survival, Bhatnagar emphasizes. MRD negativity is a reasonable end point to use when translating clinical trial findings into meaningful information for patients, Bhatnagar concludes.

Bhavana “Tina” Bhatnagar, DO, discusses the investigation of minimal residual disease negativity in patients with acute myeloid leukemia. 

Bhavana Bhatnagar, DO

Articles

Dr Bhatnagar on AlloSCT Outcomes After Blinatumomab/Chemo in MRD-Negative B-ALL

Dr Bhatnagar on Survival Outcomes With MRD Negativity in AML