Blinatumomab as a Bridge Therapy to Hematopoietic Stem Cell Transplantation in a Patient With B-cell Acute Lymphoblastic Leukemia Refractory to Multiple Chemotherapy Regimens: Achievement of Measurable Residual Disease Negativity and Impact on Outcome
Year: 2026
Type: article
Study design: Case Report
Abstract: Background The status of measurable residual disease (MRD) prior to bone marrow transplantation (BMT) is the single most important prognostic factor in B-cell acute lymphoblastic leukemia (B-ALL). Patients who remain MRD-positive after conventional chemotherapy have high rates of post-transplant relapse. Blinatumomab, a bispecific T-cell engager (BiTE) anti-CD19/CD3 antibody, stands out as an effective therapy for achieving MRD negativity, serving as a therapeutic bridge to allogeneic BMT. Case Report A 31-year-old female patient with B-cell ALL (B-ALL), BCR-ABL-negative, diagnosed in March 2020. In April, she began chemotherapy treatment with the augmented HyperCVAD protocol, completing six cycles. Subsequently, in December of the same year, she underwent an allogeneic bone marrow transplant. In September 2023, she presented with medullary and extramedullary relapse (pancreas, kidney, and lower limbs) and was submitted to the FLAG-Dauno protocol in December 2023, with dexamethasone in the pre-phase and maintenance with the POMP protocol. In June 2024, she had a new relapse, at which point the use of blinatumomab was proposed. Treatment was conducted according to the drug manufacturer’s protocol, with appropriate clinical and laboratory monitoring. During the three treatment cycles, the patient demonstrated good tolerability, although she developed some known adverse events associated with blinatumomab, such as cytokine release syndrome and neurotoxicity, as well as other uncommon reactions such as hepatotoxicity and pancreatitis, which were clinically significant; however, with appropriate clinical management and monitoring, treatment could be continued. At the end of each treatment cycle, flow cytometry analysis demonstrated a complete molecular response, achieving negative minimal residual disease (MRD) (< 0.01%). The response achieved allowed the patient to be referred for a second allogeneic transplant. Discussion: Achieving negative measurable residual disease (MRD) prior to bone marrow transplantation (BMT) is one of the key determinants of improved overall survival and a lower risk of relapse in patients with B-cell acute lymphoblastic leukemia (B-ALL). Clinical studies demonstrate that blinatumomab is highly effective in eradicating residual disease and has a more favorable toxicity profile compared to intensive chemotherapy. This case report reinforces its relevance as a bridging therapy, allowing patients initially ineligible for transplantation due to persistent disease to achieve remission, particularly in patients refractory to various conventional therapies. This case highlights the importance of incorporating immunotherapies into the modern management of ALL and underscores the importance of serial MRD monitoring for personalized therapy. Conclusion The use of blinatumomab enabled the conversion from active disease to measurable residual disease negativity, even in a patient refractory to multiple chemotherapy regimens, thereby enabling a second allogeneic hematopoietic stem cell transplant under more favorable prognostic conditions. This report reinforces the role of blinatumomab as an effective pharmacotherapeutic tool for treating refractory patients with active disease in preparation for HSCT, and highlights the importance of MRD assessment as a decisive marker in the therapeutic management of B-cell ALL.
Authors: Elder Trindade DAMASCENO, Leonardo Augusto Toledo KISTER, Luana Sávia Santos SILVA, Ivana Moura Leal COELHO, Maisa Rafaele Silva SILVA, Mônica Lopes Sampaio SILVA, Hebert Henrique Melo SANTOS, Rafaela Leal Machado BORGES, Alessandro Moura ALMEIDA, Marianna Batista Vieira LIMA, Cristiane Almeida Requião PINNA, Daniela Dourado DUTRA, Edvan Queiroz CRUSOE
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223110698