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
- 1Hospital Universitário Professor Edgard Santos (HUPES-UFBA), Salvador, BA, Brazil
- 2Instituto de Ciências da Saúde (ICS-UFBA), Salvador, BA, Brazil
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.
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- SEVERE HEPATOTOXICITY AND ACUTE PANCREATITIS ASSOCIATED WITH THE USE OF BLINATUMOMAB IN A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA
BibTeX
@article{damasceno2026blinatumomab,
title = {{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}},
author = {Elder Trindade DAMASCENO and Leonardo Augusto Toledo KISTER and Luana Sávia Santos SILVA and Ivana Moura Leal COELHO and Maisa Rafaele Silva SILVA and Mônica Lopes Sampaio SILVA and Hebert Henrique Melo SANTOS and Rafaela Leal Machado BORGES and Alessandro Moura ALMEIDA and Marianna Batista Vieira LIMA and Cristiane Almeida Requião PINNA and Daniela Dourado DUTRA and Edvan Queiroz CRUSOE},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.107563},
url = {https://doi.org/10.1016/j.htct.2026.107563},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Elder Trindade DAMASCENO
AU - Leonardo Augusto Toledo KISTER
AU - Luana Sávia Santos SILVA
AU - Ivana Moura Leal COELHO
AU - Maisa Rafaele Silva SILVA
AU - Mônica Lopes Sampaio SILVA
AU - Hebert Henrique Melo SANTOS
AU - Rafaela Leal Machado BORGES
AU - Alessandro Moura ALMEIDA
AU - Marianna Batista Vieira LIMA
AU - Cristiane Almeida Requião PINNA
AU - Daniela Dourado DUTRA
AU - Edvan Queiroz CRUSOE
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.107563
UR - https://doi.org/10.1016/j.htct.2026.107563
AB - 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.
SN - 2531-1379
SN - 2531-1387
ER -