BLAST: Blinatumomab for minimal residual disease in patients with ALL

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Published: 23 Jan 2020
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Dr Renato Bassan - Ospedale dell'Angelo & Ospedale SS, Venice, Italy

Dr Renato Bassan speaks to ecancer at the 2020 ALL Assembly meeting in Frankfurt about a study looking into the management of minimal residual disease (MRD) in patients with acute lymphoblastic leukaemia (ALL).

He discusses the BLAST study, which evaluated the safety and effectiveness of the bispecific T-cell engager blinatumomab for the treatment of acute lymphoblastic leukaemia (ALL) with minimal residual disease (MRD).

Dr Bassan describes the results of this study as extremely interesting, as 80 of patients achieved MRD negativity with reduced toxicity.

 

There are studies, MRD directed studies, just to say the most important one was the BLAST
programme that was finished, analysed and published with this bispecific agent, blinatumomab, which
is a bispecific antibody targeting at the same time CD19 positive blast cells, B lineage ALL, and
normal CD3 positive T-cells. The mechanism is that blinatumomab engages these CD3 positive T-
cells against the leukemic blasts and the T-cells kill the leukaemia cells in the end. This agent was
used in monotherapy in a large international study, the BLAST, on MRD positive patients. It was adult
patients and, most interestingly, they expressed high levels of minimal residual disease – from 10 -3
and higher which is an aggravation of the prognostic significance of MRD.

The results were extremely interesting because, with little toxicity and it could be administered as
outpatient, 80% of these patients converted to molecularly negative status which improved their
outcome compared to the historical control group, roughly 25% survival. It was with the BLAST trial
something like 60% complete MRD responders. Many of them were transferred to transplantation,
roughly 70%, that was a successful strategy confirming the ability of blinatumomab to obtain an MRD
negative condition, allowing many more patients to be transplanted and improving the transplant
results. Quite positive information.