Efficacy and Prognosis of Blinatumomab As a Bridge Therapy for Hematopoietic Stem Cell Transplantation for B-ALL

Objective: Patients with B-ALL were included in the study. MRD of the target genes was quantified using a multiparameter Flow cytometry, and the bridged Hematopoietic stem cell transplantation was performed after 7 days of 28 UG of Blinatumoma treatment, it uses dexamethasone to prevent CRS, Levetiracetam to prevent ICAN, and trimetazidine to nourish the myocardium. Methods: Forty-four patients (22 female, 22 male) , with a median age of 36.5(13-60 years) . In 19 patients with Ph positive, MRD remained negative before and after transplantation in 14 patients and MRD clearance was achieved in 5 patients, while in 25 patients with Ph negative, MRD remained negative before and after transplantation in 21 patients and MRD clearance was achieved in 4 patients. During treatment with Emil Adolf von Behring, 16 patients (36.4%) developed grade 1 CRS, 1 patient developed Grade 2 CRS, and 1 patient developed grade 3 CRS. Two patients developed ICAN and one patient developed severe arrhythmia, so Emil Adolf von Behring was discontinued. All the 41 patients achieved deep remission after treatment with belintoin. On Blinatumomab, allogeneic Hematopoietic stem cell transplants were performed after a median interval of 0 days (0-40 days) , with 17 patients receiving single cord blood transplants, fifteen patients were treated with HID-HSCT in combination with cord blood transplantation, and 9 patients were treated with MSD-HSCT in combination with cord blood transplantation. With a median follow-up of 11 months, 41 patients had 1-year OS and PFS of 77.9% and 76.9% , respectively, and 10 MRD positive patients had 1-year OS and PFS of 66.4% and 65.6% , respectively, the 1-year OS and PFS of 31 MRD negative patients were 82.4% and 82% , respectively. Nine patients died after transplantation, including 9 from severe infection, 2 from GVHD and 3 from relapse. Result: Bridging transplantation after 7 days of continuous use of Blinatumoma has been shown to improve remission rates and long-term survival in patients with B-ALL, particularly in MRD-negative patients.