Incorporation of Immunotherapy Into Adult B-Cell Acute Lymphoblastic Leukemia Therapy

Blinatumomab and inotuzumab ozogamicin have demonstrated efficacy in treating relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) and improving outcomes compared with conventional chemotherapy. Encouraging results have been observed in both younger and older patients with Philadelphia chromosome (Ph)–positive and Ph-negative B-ALL treated with these immunotherapy agents across several clinical trials. Treatment with inotuzumab ozogamicin and/or blinatumomab leads to high rates of deep measurable residual disease negativity and may enhance survival compared with chemotherapy-only approaches, reducing the need for intensive chemotherapy, and potentially the need for allogeneic stem cell transplantation. Herein, we review the incorporation of blinatumomab and/or inotuzumab ozogamicin into frontline B-ALL regimens, including the potential use of chemotherapy-free approaches in select patient subgroups. We also explore the potential role of CAR T-cell therapies in the frontline setting for high-risk patients, as well as novel strategies to further improve outcomes in patients with B-ALL.