Comparison of blinatumomab and CAR T-cell therapy in relapsed/refractory acute lymphoblastic leukemia: a systematic review and meta-analysis

ABSTRACT

Objectives

This study evaluated the benefits and risks of patients with refractory or relapsed acute lymphocytic leukemia (R/R ALL) treated with anti-CD19 chimeric antigen receptor (CAR) T-cell therapy and blinatumomab.

Methods

PubMed, Web of Science, Embase, and the Cochrane Library were searched for relevant studies.

Results

The pooled complete remission (CR) rate and minimal residual disease (MRD) negative rate were 48%, 31% for blinatumomab, and 86% and 80% for CAR T-cell therapy.

Conclusions

The CAR T-cell therapy group exhibited a higher likelihood of CR rate than the blinatumomab group in every analysis regardless of adjustment subgroups. CAR T-cell therapy was associated with a significantly prolonged overall survival (OS) and relapse-free survival (RFS) compared with blinatumomab (2-year OS 55% vs 25%; 2-year RFS 40% vs 22%). CAR T-cell therapy was more effective for achieving CR and bridging to allogeneic hematopoietic stem cell transplantation (allo‐SCT) than blinatumomab (2-year OS 75% vs. 57%). An emerging role for blinatumomab is as a bridging agent pre-SCT, and for patients who achieve an MRD-negative state pre-SCT, post-SCT outcomes are expected to be the same as CAR-T. For adverse effects (AEs), blinatumomab was associated with a lower rate of grade ≥3 hematological toxicity, CRS, and neurological events.

KEYWORDS:

• Blinatumomab
• chimeric antigen receptor T cell therapy
• CAR T
• acute lymphoblastic leukemia
• ALL
• relapsed/refractory acute lymphoblastic leukemia

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A peer reviewer on this manuscript is an advisory board member for Gilead and Medison. A peer reviewer for this manuscript has served on the advisory board of Novartis and Cargo Therapeutics. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Zhigang Zhao, Hongjie Zhan, and Yixin Zhai designed the study. Yixin Zhai, Jinhuan Wang, Yanan Jiang, Wenqi Wu, Yangyang Lv, Donghui Xing, Hong Xu, and Huimeng Sun provided material. Yixin Zhai extracted the data. Yixin Zhai, and Zhigang Zhao performed the work and statistical analyses. Yixin Zhai and Ju Hong wrote the paper. All authors read and approved the final manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474086.2023.2298732.

Additional information

Funding

This manuscript was funded by the National Natural Science Foundation of China [81870150 and 81670102] and the Tianjin Key Medical Discipline (Specialty) Construction Project [TJYXZDXK-009A].