The ECOG-ACRIN E1910 trial, a National Clinical Trials Network intergroup study in the United States, investigated the efficacy of adding blinatumomab (Blincyto) to standard chemotherapy in adult patients with B-cell precursor acute lymphoblastic leukemia (ALL). The trial enrolled 488 patients aged 30 to 70 years with Philadelphia chromosome-negative B-ALL.
Following two months of induction chemotherapy, patients achieving a conventional morphologic complete remission (81% of the cohort) proceeded to an intensification cycle including central nervous system prophylaxis. Measurable residual disease (MRD) status was then assessed via flow cytometry. MRD-negative patients were randomized to either a control arm of four cycles of conventional consolidation chemotherapy followed by maintenance therapy or the experimental arm consisting of the same chemotherapy regimen plus four cycles of blinatumomab.
In the blinatumomab arm, patients received two cycles of the drug (administered as a continuous intravenous infusion over four weeks) interspersed with three cycles of chemotherapy, followed by another cycle of blinatumomab, another cycle of chemotherapy, and a final blinatumomab cycle. Both groups then continued on maintenance therapy. Investigators allowed patients in either arm to undergo allogeneic transplant at the discretion of their physician; approximately 20% of patients ultimately received a transplant.
The study, led by Mark R. Litzow, MD, from the Mayo Clinic, suggests that the addition of blinatumomab to chemotherapy may improve outcomes in this patient population, potentially reducing the need for allogeneic transplants.
