Prof Martin Schrappe speaks to ecancer about a randomized trial that evaluated whether blinatumomab could safely replace highly intensive chemotherapy in children with newly diagnosed high-risk B-cell acute lymphoblastic leukaemia (ALL).

Patients received two cycles of blinatumomab instead of conventional chemotherapy blocks.

The study demonstrated an improvement in outcomes, with 4-year event-free survival reaching 83% in the blinatumomab arm versus 70% with standard chemotherapy. Relapse rates, including central nervous system relapse, were lower, and minimal residual disease responses were substantially improved with blinatumomab.

Treatment with blinatumomab resulted in fewer severe toxicities, including significantly reduced infections, mucositis, and treatment-related mortality, despite a modest increase in manageable neurologic events.

Prof Schrappe suggests these findings establish blinatumomab as a safer and more effective alternative to intensive chemotherapy, supporting a shift toward immunotherapy-based treatment strategies in high-risk paediatric ALL.