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Response to blinatumomab or inotuzumab ozogamicin for isolated extramedullary relapse of adult acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation: a case study

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Abstract

Isolated extramedullary relapse (EMR) without bone marrow relapse (BMR) after allogeneic hematopoietic cell transplantation (allo-HCT) is a rare condition in patients with acute lymphoblastic leukemia (ALL), and the role of immunotherapeutic agents for these patients remains unclear. We analyzed treatment outcomes of blinatumomab or inotuzumab ozogamicin (INO) as first- or second-line salvage therapy in nine patients with Philadelphia chromosome-negative B-cell precursor ALL presenting with isolated EMR after previous allo-HCT. In seven patients receiving blinatumomab as first-line salvage therapy, 4 (57.1%) achieved complete remission (CR). Among the three patients without remission after blinatumomab, two switched to INO and subsequently showed responses {one CR and one partial response [PR]}, and one switched to multiagent chemotherapy that led to CR. In the two patients receiving first-line salvage therapy with INO, one showed PR and the other achieved CR. Overall, 6 (66.7%) of nine patients achieved CR, and five of them proceeded to allo-HCT in CR. The median overall survival after relapse was 27.8 months. In conclusion, both blinatumomab and INO showed good response rates and a safe bridging role to second allo-HCT in patients with isolated EMR. However, clinical differences between isolated EMR and EMR with BMR remain to be elucidated.

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Author notes

  1. Jae-Ho Yoon and Seung-Hwan Lee equally contributed to the manuscript as first authors.

Authors and Affiliations

  1. Department of Hematology, Seoul St. Mary’s Hospital, Catholic Hematology Hospital and Leukemia Research Institute, Seoul, Republic of Korea

    Jae-Ho Yoon, Gi June Min, Sung-Soo Park, Silvia Park, Sung-Eun Lee, Byung-Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Hee-Je Kim, Chang-Ki Min, Seok-Goo Cho, Jong Wook Lee & Seok Lee

  2. College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Seung-Hwan Lee, Jae-Ho Yoon, Gi June Min, Sung-Soo Park, Silvia Park, Sung-Eun Lee, Byung-Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Hee-Je Kim, Chang-Ki Min, Seok-Goo Cho, Jong Wook Lee & Seok Lee

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  1. Seung-Hwan Lee
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  2. Jae-Ho Yoon
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  3. Gi June Min
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  4. Sung-Soo Park
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  5. Silvia Park
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  6. Sung-Eun Lee
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  8. Ki-Seong Eom
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  11. Chang-Ki Min
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  12. Seok-Goo Cho
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  13. Jong Wook Lee
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  14. Seok Lee
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Correspondence to Seok Lee.

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Lee, SH., Yoon, JH., Min, G.J. et al. Response to blinatumomab or inotuzumab ozogamicin for isolated extramedullary relapse of adult acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation: a case study. Int J Hematol 115, 135–139 (2022). https://doi.org/10.1007/s12185-021-03231-6

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  • DOI: https://doi.org/10.1007/s12185-021-03231-6

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