Although complete remission rates in adults with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) have improved over the last 2 decades, it is still inferior to that of the pediatric population, and once in remission, the risk of relapse is still high. Furthermore, although pediatric-inspired chemotherapy regimens have improved long-term outcomes for adolescents and young adults, these intensive chemotherapy regimens are not well tolerated in older patients and are associated with higher morbidity and mortality. Immunotherapeutic agents offer a potential opportunity to improve response and decrease relapse without increasing toxicity. The incorporation of rituximab (anti-CD20 monoclonal antibody) into chemotherapy regimens has been shown to improve outcomes. The treatment of BCP-ALL in adults has been transformed with the approval of inotuzumab ozogamicin (anti-CD22 antibody-drug conjugate), blinatumomab (CD3/CD19 bispecific antibody construct), and chimeric antigen receptor T cells for relapsed or refractory disease and of blinatumomab for measurable residual disease (MRD)–positive remission. More recently, studies of inotuzumab and blinatumomab have shown promising results when used up front either with or without multiagent chemotherapy. Blinatumomab has also been shown in a randomized trial to provide a survival benefit in patients with MRD-negative first remission when added to chemotherapy, which recently led to its additional US Food and Drug Administration approval for use in consolidation. In this review, we highlight the evolution of chemoimmunotherapy-based treatment approaches in the management of treatment-naïve BCP-ALL.
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Acute Lymphoblastic Leukemia|
April 3, 2025
Incorporation of immunotherapy into frontline treatment for adults with B-cell precursor acute lymphoblastic leukemia
Talha Badar,
Talha Badar
1Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL
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Selina M. Luger,
Selina M. Luger
2Abramson Cancer Center and Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA
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Mark R. Litzow
Mark R. Litzow
3Division of Hematology, Mayo Clinic, Rochester, MN
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Blood (2025) 145 (14): 1475–1484.
Article history
Submitted:
February 20, 2024
Accepted:
August 6, 2024
First Edition:
September 5, 2024
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Citation
Talha Badar, Selina M. Luger, Mark R. Litzow; Incorporation of immunotherapy into frontline treatment for adults with B-cell precursor acute lymphoblastic leukemia. Blood 2025; 145 (14): 1475–1484. doi: https://doi.org/10.1182/blood.2023022921
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