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Interleaving an immunotherapy with standard chemotherapy cycles improves survival in adults and children with newly diagnosed ALL.
Adding blinatumomab, a CD19-directed bispecific T-cell engager, to frontline chemotherapy cycles is a combination pairing that improves survival in both adults and children with newly diagnosed B-cell acute lymphoblastic leukaemia. Chemotherapy reduces the bulk of disease and the immunosuppressive burden, after which blinatumomab engages the patient's recovering T cells against residual CD19-positive blasts. Two phase 3 trials, ECOG-ACRIN E1910 in adults who were already in MRD-negative remission and Children's Oncology Group AALL1731 in children with standard-risk disease, were both stopped early because of benefit. Blinatumomab is now a standard part of consolidation regardless of MRD status, and the linked papers describe both trials.
AALL1731 brings immunotherapy into the front-line treatment of the commonest childhood cancer, in the group of children where most relapses were occurring despite good initial risk. Blinatumomab was approved for this use in 2024 and paediatric protocols worldwide are being amended. Whether it can allow less chemotherapy, and its effect on very low-risk children, are the next questions.
E1910 changed the standard of care for adult B-ALL: immunotherapy is now part of front-line consolidation even for patients with no detectable leukaemia, because MRD-negative by flow cytometry does not mean cured. It also demonstrated that a T-cell engager can improve overall survival in a curative setting. Chemotherapy-light or chemotherapy-free regimens built on blinatumomab and inotuzumab are the next step.
Shares COG AALL1731, Children's Oncology Group AALL1731: blinatumomab added to chemotherapy for children with standard-risk B-cell ALL, Blinatumomab, CD19.
Shares ECOG-ACRIN E1910, ECOG-ACRIN E1910: adding blinatumomab to chemotherapy for adults with B-cell ALL already in MRD-negative remission, Blinatumomab, CD19.
Shares COG AALL1731, Children's Oncology Group AALL1731: blinatumomab added to chemotherapy for children with standard-risk B-cell ALL, Blinatumomab, CD19.
Shares COG AALL1731, Children's Oncology Group AALL1731: blinatumomab added to chemotherapy for children with standard-risk B-cell ALL, Blinatumomab, Acute lymphoblastic leukaemia.
Shares ECOG-ACRIN E1910: adding blinatumomab to chemotherapy for adults with B-cell ALL already in MRD-negative remission, Blinatumomab, CD19, Acute lymphoblastic leukaemia.
Shares COG AALL1731, Standard-risk B-cell acute lymphoblastic leukaemia in children, Acute lymphoblastic leukaemia.
Shares Blinatumomab, CD19, Acute lymphoblastic leukaemia.
Shares Blinatumomab, CD19, Acute lymphoblastic leukaemia.