Advances in ALL at ASH Meeting Include New Blinatumomab Data and More

In the phase III ECOG-ACRIN E1910 study presented at the American Society of Hematology (ASH) annual meeting, consolidation chemotherapy with blinatumomab (Blincyto) improved overall survival in patients with newly diagnosed measurable residual disease (MRD)-negative B-lineage acute lymphoblastic leukemia (ALL). Other studies also looked at blinatumomab, MRD, and personalized approaches in ALL treatment.

Ahead of the presentations at ASH, MedPage Today spoke to Selina M. Luger, MD, of the University of Pennsylvania in Philadelphia, who offered a summary of some key studies.

Following is a transcript of her remarks:

ECOG-ACRIN E1910 is a [study] that we recently published that looked at the role of blinatumomab in consolidation therapy in adults in newly diagnosed ALL. All patients received standard induction therapy and then those who were MRD negative were randomized to either receive or not receive blinatumomab in addition to their consolidation therapy.

And we were able to demonstrate a significant survival benefit in those who received blinatumomab compared to those who did not receive blinatumomab in the MRD-negative population — so the patient population in whom we thought there was really no risk of relapse — there was a significant risk of relapse in those who did not receive blinatumomab, and we improved survival by 17% by giving blinatumomab to the patient population who were MRD negative in consolidation.

This year, I would say that there are a few different studies that are addressing this issue and we are presenting data on the older population to see whether or not we were able to demonstrate a benefit in that older population. And it’s hard with the numbers that we had in that study of older patients to demonstrate a statistically significant benefit.

The other study that we are presenting is outcome of those who underwent transplant after receiving blinatumomab and whether or not blinatumomab impacted transplant and whether transplant was still necessary in those who received blinatumomab.

There are a few other studies that are addressing some of these issues at the meeting this year, at the plenary session this afternoon, we’ll be hearing about a pediatric study that addressed these questions in a similar way. It was the upfront study in the Children’s Oncology Group that looked at the role of blinatumomab in consolidation therapy of their patient population. We’ll be hearing about that this afternoon.

And then there are several studies that will be in an ALL session tomorrow afternoon that I will be moderating that we’ll be asking some questions about how we can use MRD to make decisions about treatments with ALL, how we can use the prognostic factors that we find out about our patients at the time of diagnosis to help determine who can receive less intensive therapy, who needs more intensive therapy, and then whether or not we should be thinking about something in addition to even blinatumomab. Is there a role for CAR T cells in patients with newly diagnosed ALL who have achieved remission? Can we improve our outcomes even further?

And so we’re trying to establish whether or not blinatumomab and other immunotherapies are of benefit and what tools we have in MRD and in genomics in assessing our ALL patients to understand who’s best to receive these therapies.