FDA Grants Approval to Blinatumomab Consolidation Therapy for CD19-Positive Philadelphia Chromosome-Negative B-cell Precursor ALL

On June 14, 2023, the Food and Drug Administration (FDA) granted approval to blinatumomab for adult and pediatric patients 1 month and older with CD19-positive Philadelphia chromosome-negative B-cell precursor (Ph-negative BCP) acute lymphoblastic leukemia (ALL) in the consolidation phase of multi-phase chemotherapy.

Investigators analyzed this treatment in two separate trials. The first, Study E1910, was a randomized, controlled trial including adult patients with newly diagnosed Ph-negative BCP ALL. Eligible patients in hematologic complete remission (CR) or CR with incomplete peripheral blood count recovery following induction and intensification chemotherapy were randomized 1 to 1 to receive a consolidation regimen comprised of multiple blinatumomab monotherapy cycles plus multiple cycles of intensive chemotherapy (blinatumomab arm) or to intensive chemotherapy alone (chemotherapy arm).

This randomization of patients in the study was stratified by age, CD20 status, rituximab use, and intent to undergo allogeneic hematopoietic stem cell transplantation (HSCT). There were 112 patients randomized to the blinatumomab arm and 112 to the chemotherapy arm. The major efficacy outcome measure was overall survival (OS). The 3-year OS was 84.8% (95% CI: 76.3 to 90.4) and 69% (95% confidence interval [CI], 58.7, 77.2) in the blinatumomab and chemotherapy arms, respectively. The hazard ratio [HR] for OS was 0.42 [95% CI, 0.24 to 0.75] p-value 0.003). In a later analysis with a median follow-up of 4.5 years, the 5-year OS was 82.4 % [95% CI (73.7 to  88.4)] in the blinatumomab arm and 62.5 % [95% CI, 52.0 to 71.3] in the chemotherapy arm. The hazard ratio was 0.44 [95% CI, 0.25 to 0.76)].

Efficacy also was evaluated in Study 20120215, a randomized, controlled, open-label, multicenter trial. In this study, pediatric and young adult patients with Ph-negative BCP ALL were randomized 1 to 1 to receive blinatumomab or the IntReALLHR2010 HC3 intensive combination chemotherapy as the third consolidation cycle. Randomization was stratified by age, minimal residual disease status at the end of induction based on local assessment, and bone marrow status at the end of the second block of consolidation chemotherapy.

In this trial, there were 54 patients randomized to the blinatumomab arm and 57 to the chemotherapy arm. The major efficacy outcome measures were OS and relapse-free survival (RFS). The 5‑year OS was 78.4% (95% confidence interval [CI], 64.2 to 87.4) and 41.4% (95% CI, 26.3 to 55.9) in the blinatumomab and chemotherapy arms, respectively (OS HR 0.35 [95% CI, 0.17 to 0.70]). The 5-year RFS was 61.1% (95% CI, 46.3 to 72.9) and 27.6% (95% CI, 16.2 to 40.3) in the blinatumomab and chemotherapy arms, respectively (RFS HR 0.38 [95% CI, 0.22 to 0.66].

As far as safety in each trial, in Study E1910 the most common adverse reactions in the blinatumomab arm were found to be neutropenia, thrombocytopenia, anemia, leukopenia, headache, infection, nausea, lymphopenia, diarrhea, musculoskeletal pain, and tremor. In Study 20120215, the most common adverse reactions in the blinatumomab arm were pyrexia, nausea, headache, rash, hypogammaglobulinemia, and anemia.

Source:

FDA approves blinatumomab as consolidation for CD19-positive Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia. Press Release. The US Food and Drug Administration. Published online June 14, 2023. Accessed June 21, 2023. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-blinatumomab-consolidation-cd19-positive-philadelphia-chromosome-negative-b-cell