Seminar presentation for Skills IX (P3 year)

1. Blinatumomab as Bridge Therapy to
Transplant in Pediatric Patients with
First-Relapse B-Cell Acute
Lymphoblastic Leukemia
Anna Sandler, PharmD Candidate, 2023
Pharmacy Skills IX
April 14th, 2022
1

2. Introduction: B-cell Acute
Lymphoblastic Leukemia (B-ALL)
2
Growing field Pediatric literature Role for pharmacists
https://www.istockphoto.com/photos/oncology. Accessed March 30, 2022
John Hopkins Medicine. https://www.hopkinsmedicine.org/johns-hopkins-childrens-center/what-we-treat/specialties/oncology/. Accessed March 30, 2022
Statnews. https://www.statnews.com/2019/02/06/cancer-treatment-at-home-safe-effective/. Accessed March 30, 2022

3. Learning Objectives
 Explain the epidemiology and pathophysiology of
relapsed B-ALL
 Identify current treatment options for relapsed B-
ALL and their limitations
 Evaluate literature to determine the role of
blinatumomab in relapsed B-ALL
 Formulate a treatment plan for a patient case
3

4. Patient case
LP is a nine-year old female brought to the ED at 0310 after waking
up in the middle of the night, shivering and sweating. Her mother
notes a recent 10-pound weight loss. LP has a PMH of B-ALL and is
currently in remission. The oncologist reveals LP’s ALL has returned,
and LP is started on re-induction therapy for 4 weeks.
Current
Medications
Physical
Exam/Vitals
PMH
• B-ALL
• Dx 11/2019
• In remission
• Maintenance
chemotherapy
* for ~ 2 years
CBC (@ 0344)
03.16.2022 04.14.2022 Future?
• Weight: 29
kg
• Height:
132.1 cm
• Temp: 100.7
NCCN guidelines, https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1410, accessed
March 15, 2022
• ANC: 600[L]
• Blasts: 20%[H]
• WBC: 12
• Plt: 90[L]
4

5. Patient case-continued
Today, a bone marrow (BM) biopsy is obtained to evaluate LP’s status
after 4 weeks of re-induction treatment. LP’s oncologist recommends a
hematopoietic stem cell transplant (HSCT).
Bone Marrow
Biopsy (@ 0701)
03.16.2022 04.14.2022 Future?
• Flow
cytometry: (+)
CD19
• MRD > 0.1%
Lumbar
Puncture
• Negative for
CNS disease
Patient
Classification
• Isolated BM
B-ALL
• Early-relapse
• High-risk
5

6. Clinical Question
During rounds, LP’s oncologist turns to you and asks
whether she would be a good candidate for blinatumomab to
bridge her before transplant.
What would you recommend?
03.16.2022 04.14.2022 Future?
6
Re-induction HSCT

7. B-Cell Acute Lymphoblastic Leukemia
Background Brown et al. Locatelli et al. Conclusion
• Comprises 80-85%
of ALL
• Most common
childhood
cancer, > 25%
Belson M, et al. Environmental Health Perspectives. 2007;115(1):138-145. doi:10.1289/ehp.9023
CDC https://www.cancer.org/cancer/acute-lymphocytic-leukemia/about/key-statistics.html. Accessed
March 11, 2022.
Chang JH, et al. Pediatr Blood Cancer. 2021;68(S2). doi:10.1002/pbc.28371
7
Rate
per
100,000
persons
Year
Rate of new cases
Death Rate

8. Pathophysiology
Background Brown et al. Locatelli et al. Conclusion
• B-ALL: Unregulated growth
of B-cell lymphoBLASTs
• Immature cells
• Isolated to BM or outside-
extramedullary
• Relapse: Return of blasts after
treatment
American Society of Hematology (ASH)
https://imagebank.hematology.org/image/61569/ball-blasts-in-blood, accessed
March 11, 2022
National Cancer Institute https://www.cancer.gov/types/leukemia/patient/child-all-
treatment-pdq, accessed March 11, 2022
8

9. Diagnosis
Background Brown et al. Locatelli et al. Conclusion
Chang JH, et al. Pediatr Blood Cancer. 2021;68(S2). doi:10.1002/pbc.28371
Biopsy
Microscopy +
Flow cytometry
Detection of
blasts
Measurable residual disease (MRD): Remaining blasts after
treatment; Negative MRD < 0.01%
First dx: > 20% blasts
Relapse: Return of blasts
Remission: <5% blasts
9

10. Survival in relapsed B-ALL is poor
Background Brown et al. Locatelli et al. Conclusion
Nguyen K, Devidas M, Cheng SC, et al. Leukemia. 2008;22(12):2142-2150. doi:10.1038/leu.2008.251
• First-relapse
• 5-year survival
rate: 25-50%
• Non-relapsed
• 5-year survival
rate: 69.9%
20-25% of
Children still
relapse
10

11. Clinical Presentation
Background Brown et al. Locatelli et al. Conclusion
•Leukocytosis and Infection
•Thrombocytopenia
•Anemia
Myelosuppression
•Lymphadenopathy
•CNS effects
Metastasis
•Recurrent fevers and unexplained weight loss
•Bleeding
Feeling unwell
CMP
CBC
PT/PTT
Physical
Exam
Patient
History
Blackburn LM et al. Seminars in Oncology Nursing. 2019;35(6):150950. doi:10.1016/j.soncn.2019.150950
11

12. Background Brown et al. Locatelli et al. Conclusion
González Llano O. Medicina Universitaria. 2016;18(73):216-218. doi:10.1016/j.rmu.2016.07.006
Raetz EA, et al. Hematology Am Soc Hematol Educ Program. 2012;2012:129-136.
doi:10.1182/asheducation-2012.1.129 12
Achieve remission
Prevent relapses
Prolong survival
Treatment
Goals of
relapsed B-
ALL

13. Current Treatment of relapsed B-ALL
Background Brown et al. Locatelli et al. Conclusion
I.
•Re-induction
•Dexamethasone, vincristine, mitoxantrone, pegaspargase
II.
•Consolidation
•Dexamethasone, vincristine, MTX, pegaspargase,
cyclophosphamide, etoposide, cytarabine, leucovorin
III.
•HSCT
•Early, high-risk relapse
Hunger SP et al. Blood. 2020;136(16):1803-1812. doi:10.1182/blood.2019004043
Pulsipher MA, et al. Blood. 2015;125(22):3501-3508. doi:10.1182/blood-2014-12-615757 13
Goal: Remission (< 5% blasts)
Optimal candidates: Non-infected, (-) MRD
Blinatumomab?

14. Blinatumomab (BLINCYTO®)
Background Brown et al. Locatelli et al. Conclusion
• Anti-CD19/CD3
mAb
• Bispecific T-cell
engager (BiTE)
• Links T cells and
malignant B cells
• Directs cell lysis
Class/MOA Indications
• CD19 positive B-
ALL in first or
second complete
remission (CR) +
MRD ≥ 0.1%
14
BLINCYTO® (blinatumomab) Published online February 2022. Accessed March 12, 2022.
Springer.com.https://link.springer.com/article/10.1007/s40264-018-0760-1. Accessed March 12, 2022

15. Blinatumomab (BLINCYTO®)
Background Brown et al. Locatelli et al. Conclusion
PK
• Elimination half life:
• 2.04 +/- 1.35 hrs
• Metabolism
• Peptide
degradation
• Excretion:
• Urine (negligible)
ADRs BBW
• Edema
• Infusion-related
reactions
• Pancreatitis
• Lymphocytopenia
• 24/48 hr infusions
• Cytokine release
syndrome
• Fever
• Hypotension
• Neurological
toxicities
• Tremors
• Seizures
• Loss of
consciousness
Administration
15
BLINCYTO® (blinatumomab) for injection, for intravenous use full
prescribing information. Published online February 2022. Accessed
March 12, 2022.

16. Clinical Question: Place in Therapy
Background Brown et al. Locatelli et al. Conclusion
Oskarsson T, et al. Pediatr Blood Cancer. 2018;65(4):e26909. doi:10.1002/pbc.26909
Queudeville M et al. JCM. 2021;10(12):2544. doi:10.3390/jcm10122544Ind 16
Re-induction HSCT

17. Background Brown et al. Locatelli et al. Conclusion
Effect of Postreinduction Therapy
Consolidation With Blinatumomab vs.
Chemotherapy on Disease-Free Survival in
Children, Adolescents, and Young Adults with
First Relapse B-cell Acute Lymphoblastic
Leukemia
A Randomized Clinical Trial
Patrick A. Brown, MD; Lingyun Ji, PhD; Xinxin Xu, MS, et al. (2021)
Literature Review:
AALL1331 Trial
17
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669

18. Background Brown et al. Locatelli et al. Conclusion
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669 18
•Compare the effect of post-reinduction blinatumomab to
chemotherapy on disease-free survival in high and
intermediate-risk first relapse B-ALL patients proceeding
to HSCT
•Funding: NIH, NCI, and St. Baldrick’s Foundation
Objective
•Open label, multi-center, phase III, randomized control
trial
Design
• Blinatumomab: Two 28-day infusion cycles with a 7-day
break in between
•15 mcg/m2/day
Intervention

19. Background Brown et al. Locatelli et al. Conclusion
•1-30 years of age
•First-relapse B-ALL
Inclusion Criteria
•Down Syndrome
•Ph+ ALL
•Previous transplant or blinatumomab therapy
Exclusion Criteria
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
19

20. Background Brown et al. Locatelli et al. Conclusion
Randomization
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
Randomization: Consolidation Treatment
Blinatumomab Chemotherapy
Risk stratification (MRD)
High and Intermediate relapse risk only
Re-induction chemotherapy*
Everyone
20

21. Background Brown et al. Locatelli et al. Conclusion
Randomization
High risk
Chemo
Blinatumomab
Intermediate
risk
Chemo
Blinatumomab
Randomization with stratification
1:1
21
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669

22. Background Brown et al. Locatelli et al. Conclusion
Outcomes-Efficacy
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
45%
incidence
rate
110
pts/arm 85% power
63%
improvement
22
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
Outcome Description Statistical Test
Primary Disease-free survival (DFS):
Time from randomization to
treatment failure, relapse,
secondary malignancy, or death
• ITT protocol
• Kaplan-Meier curves
• One-sided stratified
log-rank test,
P=0.025
• Stratified Cox-
Proportional HRs
Secondary Overall survival (OS)
MRD negativity and transplant
rates

23. Background Brown et al. Locatelli et al. Conclusion
Outcomes-Safety
BioAgilytix. https://www.bioagilytix.com/2020/12/02/the-importance-of-cytokine-detection-and-
analysis/. Accessed March 16, 2022.
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
• Adverse events (AEs) graded
• Severe AEs= Grade 3 or higher
• Blinatumomab-related AE monitoring
• Cytokine-release syndrome
• Neurotoxicity
23
• Descriptive statistics

24. Background Brown et al. Locatelli et al. Conclusion
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
Data and Safety Monitoring Board (DSMB)
Enrollment
start
Interim Analysis
#1
Termination
24
Enrollment start Interim Analysis
#1
Interim Analysis
#2
Planned
Reality
Efficacy stopping rule: P < 0.004
Dec 2014 Sep 2019

25. Background Brown et al. Locatelli et al. Conclusion
Results-Baseline Characteristics
Characteristic Blinatumomab (n=105)
Chemotherapy
(n=103)
Median age (IQR) 9 (6-16) 9 (5-16)
Female (%) 48 (45.7%) 49 (47.6)
White 69 (83.1) 66 (74.2)
Black/African American 7 (8.4) 18 (20.2)
Hispanic/Latino 36 (37.1) 34 (34.7)
Relapse: Marrow 41 (39.0) 41 (39.8)
Relapse: Extramedullary 10 (9.5) 10 (9.7)
High-risk 69 (65.7) 69 (67.0)
Intermediate-risk 36 (34.3) 34( 33.0)
25
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669

26. Background Brown et al. Locatelli et al. Conclusion
Results-Primary Outcome
Endpoint Blinatumomab (%)
(n=105)
Chemo (%)
(n=103)
HR (95% CI)
DFS rate (2-yr) 54.4 39.0 0.70 (0.47-
1.03); P=0.03
Disease Free Survival
Disease
Free
Survival
Rate
Years after randomization
• Median follow-up: 2.9 years
• 2-year disease-free survival
not statistically significant
26
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
Blinatumomab
Chemo
DFS

27. Background Brown et al. Locatelli et al. Conclusion
Results-Secondary Outcomes
Endpoint Blinatumomab (%)
(n=105)
Chemo (%)
(n=103)
HR (95% CI)
OS (2-yr) 71.3 58.4 0.62 (0.39-
0.98); P=0.02
Years after randomization
Overall
Survival
Rate
Overall Survival
• 2-year overall survival rates
statistically significant
• NNT~8
OS
Exploratory/Post-hoc
• Blinatumomab: Higher
transplant rates
27
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
Chemo
Blinatumomab

28. Background Brown et al. Locatelli et al. Conclusion
Results-Safety
Blinatumomab (n=102) Chemotherapy (n=97)
Any grade Grade ≥ 3 Any grade Grade ≥ 3
Patients with
any AE
99 (97.1%) 83 (81.4%) 91 (93.8%) 90 (92.8%)
Decreased
WBC
75 (73.5%) 35 (34.3%) 61 (62.9%) 59 (60.8%)
Infection 28 (27%) 15 (15%) 68 (70%) 63 (65%)
Febrile
Neutropenia
6 (5.9%) 5 (4.9%) 56 (57.7%) 56 (57.7%)
Sepsis 2 (2%) 2 (2%) 26 (26.8%) 26 (26.8%)
Oral Mucositis 5 (4.9%) 1 (1%) 50 (51.5%) 27 (27.8%)
28
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669

29. Background Brown et al. Locatelli et al. Conclusion
Results-Blinatumomab AEs
Cytokine-release
syndrome
22 (22%) 1 (1%) N/A N/A
Encephalopathy 15 (15%) 4 (4%) N/A N/A
Seizure 5 (5%) 1 (1%) N/A N/A
No. of patients (%)
Blinatumomab (n=102) Chemotherapy (n=97)
Any grade Grade ≥ 3 Any grade Grade ≥ 3
29
• All fully
reversible,
with no AE-
related deaths
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669

30. Background Brown et al. Locatelli et al. Conclusion
Strengths and Weaknesses
• Unknown whether
DSMB was blinded
• Application limitations
• Small n
• Intermediate and high
risk only
• Majority of
participants: 9-16 y/o
• Randomization
with stratification
• Clinically
meaningful
endpoints
• Good
representation of
AEs
30
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669

31. Background Brown et al. Locatelli et al. Conclusion
Conclusions
31
Brown PA, et al. JAMA. 2021;325(9):833. doi:10.1001/jama.2021.0669
Blinatumomab >
Chemotherapy
Survival
Safety DFS
Researchers
• Consolidation blinatumomab did
not result in significantly higher
DFS compared to chemotherapy.
• Study underpowered
Presenter
• Efficacy and safety of
blinatumomab in this population
is encouraging
• Larger, longer-term studies
needed

32. Background Brown et al. Locatelli et al. Conclusion
Literature Review
Effect of Blinatumomab vs Chemotherapy on
Event-Free Survival Among
Children With High-risk First-Relapse B-Cell
Acute Lymphoblastic Leukemia
A Randomized Clinical Trial
Franco Locatelli, MD, PhD; Gerhard Zugmaier,
MD; Carmelo Rizzari, MD, et al. (2021)
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987 32

33. Background Brown et al. Locatelli et al. Conclusion
•Analyze effect of blinatumomab when substituted for the
third phase of consolidation treatment on event-free survival
in patients proceeding to transplant
•Funding: Authors received personal fees, grants, or
employment from Amgen and other companies.
Objective
• Multi-center, double-blind, randomized, phase III trial
Design
• Four-week blinatumomab infusion, 15 mcg/m2/day
Intervention
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987 33

34. Background Brown et al. Locatelli et al. Conclusion
•28 days to < 18 years old
•High-risk, First-relapse B-ALL
•M1 Marrow (<5% blasts) or M2 Marrow (5-<25% blasts)
Inclusion Criteria
•Abnormal renal or hepatic function
•Ph+ ALL
•Nervous system disorders
Exclusion Criteria
34
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987

35. Background Brown et al. Locatelli et al. Conclusion
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987
Randomization
Randomization: Third cycle consolidation
Blinatumomab Chemotherapy
Two cycles chemotherapy consolidation
Everyone
Re-induction chemotherapy
Everyone
35

36. Background Brown et al. Locatelli et al. Conclusion
Randomization with stratification
Randomization
1-9 y/o
Chemo
Blinatumomab
<1 and > 9 y/o
Chemo
Blinatumomab
36
1:1
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987

37. Background Brown et al. Locatelli et al. Conclusion
Outcomes-Efficacy
Control
EFS rate 7
months
202 total
patients+
94 events
84% power+
alpha 0.05
HR 0.63
Outcome Description Statistical Test
Primary Event-free survival (EFS):
Time from randomization to
relapse, secondary
malignancy, death, or
failure to achieve CR
• ITT protocol
• Kaplan-Meier curves with
two-sided stratified log-rank
test
• Stratified Cox-Proportional
HRs
Secondary Overall survival (OS)
Cumulative relapse
incidence, MRD status
37
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987

38. Background Brown et al. Locatelli et al. Conclusion
Outcomes-Safety
• Adverse events (AEs) graded
• Blinatumomab-related AE monitoring
• Cytokine-release syndrome
• Neurotoxicity
38
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987
BioAgilytix. https://www.bioagilytix.com/2020/12/02/the-importance-of-cytokine-detection-and-
analysis/. Accessed March 16, 2022.
• Descriptive statistics

39. Background Brown et al. Locatelli et al. Conclusion
Enrollment
start
Interim
Analysis #1
Termination
Enrollment
start
Interim
Analysis #1
Interim
Analysis #2
Planned
Reality
Efficacy stopping rule: P < 0.003
Nov 2015 July 2019
39
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987
Data and Safety Monitoring Board (DSMB)

40. Background Brown et al. Locatelli et al. Conclusion
Results-Baseline Characteristics
Characteristic Blinatumomab (n=54)
Chemotherapy
(n=54)
Median age (range) 6 (1-17) 5 (1-17)
Boys (%) 30 (55.6) 22 (40.7)
White (%) 50 (92.6) 43 (79.6)
Asian (%) 1 (1.9) 3 (5.6)
Black or African American 0 3 (5.6)
Hispanic or Latino (%) 1 (1.9) 3 (5.6)
Favorable genetic profile 8 (14.8) 10 (18.5)
MRD > 0.1% (%) 29 (53.7) 28 (51.9%)
Mean months from first dx 21.9 (8.0) 22.8 (12.3)
40
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987

41. Background Brown et al. Locatelli et al. Conclusion
Results-Primary Outcome
Endpoint Blinatumomab (%)
(n=54)
Chemo (%)
(n=54)
HR (95% CI)
EFS rates (2-
year)
66.2 27.1 0.33 (0.18-0.61)
• Median follow-up: 22.4 months
• Events: 17/54 (31.5%) with
blinatumomab versus 31/54
(57.4%) with chemo
• NNT~4 patients
Months after randomization
Survival
Probability
Event-free survival
Blinatumomab
Consolidation chemo
41
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987
EFS

42. Background Brown et al. Locatelli et al. Conclusion
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987
Results-Secondary Outcomes
Endpoint Blinatumomab (%)
(n=54)
Chemo (%)
(n=54)
HR (95% CI)
Death 8 (14.8) 16 (29.6) 0.43 (0.18-
1.01)
Months after randomization
Survival
Probability
Overall Survival
Blinatumomab
Consolidation chemo
• Median follow-up: 19.5
months
OS
Other
• Blinatumomab: Decreased
Cumulative incidence of relapse
42

43. Background Brown et al. Locatelli et al. Conclusion
Results-Safety
No. of patients (%)
Blinatumomab
(n=54)
Chemotherapy
(n=51)
Grade ≥ 3 AE 31 (57.4) 42 (82.4)
Thrombocytopenia 10 (18.5) 18 (35.3)
Stomatitis 10 (18.5) 18 (31.4)
Neutropenia 9 (16.7) 16 (31.4)
Anemia 8 (14.8) 21 (41.2)
Febrile Neutropenia 2 (3.7) 13 (25.5)
Leukopenia 4 (7.4) 4 (7.8)
43
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987

44. Background Brown et al. Locatelli et al. Conclusion
Results-blinatumomab AEs
No. of patients (%)
Blinatumomab
(n=54)
Chemotherapy
(n=51)
Pyrexia
44 (81.5) 10 (19.6)
Headache 19 (35.2) 9 (17.6)
Neurological events 26 (48.1) 15 (29.4)
Seizure 2 (3.7) 0 (0.0)
Seizure-Grade 4 1 (1.9) 0 (0.0)
Cytokine release
syndrome-any
2 (3.7) 1 (2.0)
44
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987

45. Background Brown et al. Locatelli et al. Conclusion
Strengths and Weaknesses
• Small n
• “Rescue” blinatumomab
• Blinatumomab-related
AEs only in supplement
• Excluded sicker patients
(> 25% blasts)
• Application limitations
• Primarily white
• > 2/3 patients 1-9 y/o
• High-risk only
• Randomization with
stratification
• Multi-center in multiple
countries
45

46. Background Brown et al. Locatelli et al. Conclusion
Conclusions
46
Locatelli F, et al. JAMA. 2021;325(9):843. doi:10.1001/jama.2021.0987
Blinatumomab >
Chemotherapy
Safety
Relapse
EFS
Researchers
• Third cycle blinatumomab
consolidation treatment before
HSCT led to improved EFS,
decreased recurrence and less
toxicities
• More efficacious before HSCT
Presenter
• Blinatumomab was more effective
than chemo as the third block
• More studies needed to
understand safety and target
patients

47. Here we go again-Patient case
Today, another biopsy is obtained to evaluate LP’s status after 4 weeks
of re-induction treatment. LP’s oncologist recommends a bone marrow
transplant.
Bone Marrow
Biopsy (@ 0701)
03.16.2022 04.14.2022 Future?
• Flow
cytometry: (+)
CD19
• MRD > 0.1%
Lumbar
Puncture
• Negative for
CNS disease
Patient
Classification
• Isolated bone
marrow (BM)
B-ALL
• Early relapse
• High-risk
Is LP a candidate for Blinatumomab?
47

48. Here we go again-Patient case
B-ALL
•Age 9
•First relapse
Classification
•High risk (MRD > 0.1%)
•Early relapse
Recommend
03.16.2022 04.14.2022 Future?
48
• 15 mcg/m^2 28-day
• Hospitalize first 3 days
• Monitor: BBW events

49. 49
Background Brown et al. Locatelli et al. Conclusion
Conclusion: Just one piece of the puzzle
Efficacious and
Less Toxic
High and
intermediate-risk
relapse B-ALL
Building new
bridges to HSCT
Pechlivanoglou et al. Blood. 2021;138(Supplement 1):565-565. doi:10.1182/blood-2021-154193

50. 50
References
1. Belson M, Kingsley B, Holmes A. Risk Factors for Acute Leukemia in Children: A Review.
Environ Health Perspect. 2007;115(1):138-145. doi:10.1289/ehp.9023
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52. Background Brown et al. Locatelli et al. Conclusion
Thank you for your
time!
Kindpng. https://www.kindpng.com/imgv/bmJwxb_question-mark-clip-art-free-clipart-images-
image/. Accessed March 18, 2022.
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53. Blinatumomab as Bridge Therapy to
Transplant in Pediatric Patients with
First-Relapse B-Cell Acute
Lymphoblastic Leukemia
Anna Sandler, PharmD Candidate, 2023
Pharmacy Skills IX
April 14th, 2022
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