Immunotherapeutic options for management of relapsed or refractory B-cell acute lymphoblastic leukemia: how to select newly approved agents?

Abstract

Recently, immunotherapeutic agents such as inotuzumab ozogamicin (INO), blinatumomab (BLIN), and tisagenlecleucel (TISA) have been approved for treatment of relapsed or refractory (R/R) acute lymphoblastic leukemia (ALL). No head to head trials have compared these agents. Thus, various factors influence the decision to choose an appropriate treatment for R/R ALL. INO may be preferred in patients with high tumor burden; BLIN is preferred in patients with low tumor burden or to eradicate minimal residual disease (MRD). Both INO and BLIN, compared to standard chemotherapy, increase the probability of receiving subsequent hematopoietic stem cell transplant (HSCT). TISA, approved for patients ≤25 years of age, is effective regardless of tumor burden or prior receipt of HSCT and can be used as a definite treatment in some patients. Further studies comparing the efficacy, safety, and other outcomes related to different immunotherapeutic options in combination with other treatment modalities and among themselves are needed.

Keywords:

• Relapsed/refractory acute lymphoblastic leukemia
• inotuzumab ozogamicin
• blinatumomab
• tisagenlecleucel
• immunotherapy

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2019.1641802.

Additional information

Funding

This work was supported by the National Institute of General Medical Sciences, [1 U54 GM115458], which funds the Great Plains IDeA-CTR Network, and the Fred and Pamela Buffett Cancer Center Support Grant from the National Cancer Institute [P30 CA036727]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.