title: Blinatumomab: Bridging the Gap in Adult Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia.
abstract: Adult patients with acute lymphoblastic leukemia who relapse after frontline therapy have extremely poor outcomes despite advances in chemotherapy and hematopoietic stem cell transplantation. Blinatumomab is a first-in-class bispecific T-cell engager that links T cells to tumor cells leading to T-cell activation and tumor cell lysis. In December 2014, the Food and Drug Administration approved blinatumomab for treatment of relapsed or refractory Philadelphia chromosome-negative precursor B-cell acute lymphoblastic leukemia. In a phase II trial, blinatumomab produced response rates of 43%, and 40% of patients achieving a complete remission proceeded to hematopoietic stem cell transplantation. Early use of blinatumomab was complicated with adverse effects, including cytokine release syndrome and neurotoxicity. Management strategies, including dexamethasone premedication and 2-step dose escalation during the first cycle of blinatumomab, have decreased the incidence and severity of these adverse effects. Blinatumomab currently is being studied for other B-cell malignancies and has the potential to benefit many patients with CD19+ malignancies in the future.
authors: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Stephanie A
authors: SA
authors: Folan
authors: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Amber
authors: A
authors: Rexwinkle
authors: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Jane
authors: J
authors: Autry
authors: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: JCBryan@mdanderson.org.
authors: Jeffrey C
authors: JC
authors: Bryan
mesh_terms: D000328:Adult; D000367:Age Factors; D018033:Antibodies, Bispecific / Q000494:pharmacology / Q000627:therapeutic use*; D018941:Antigens, CD19 / Q000378:metabolism; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D017252:CD3 Complex / Q000378:metabolism; D002986:Clinical Trials as Topic; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008213:Lymphocyte Activation / Q000187:drug effects; D058990:Molecular Targeted Therapy; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D011485:Protein Binding; D012008:Recurrence; D012074:Remission Induction; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D018033:Antibodies, Bispecific; D018941:Antigens, CD19; D000970:Antineoplastic Agents; D017252:CD3 Complex; C510808:blinatumomab
keywords: Bispecific T-cell engager; Cytokine release syndrome; Hematopoietic stem cell transplant; Immunotherapy; Neurotoxicity