Background While blinatumomab has demonstrated substantial efficacy in relapsed/refractory B-cell acute lymphoblastic leukemia (R/R B-ALL), the therapeutic potential of combining blinatumomab with tyrosine kinase inhibitors (TKIs) and low-dose chemotherapy as frontline induction for newly diagnosed Philadelphia chromosome-positive B-ALL (Ph + B-ALL) remains systematically underexplored. This study aims to evaluate the efficacy and safety of blinatumomab in combination with low-dose chemotherapy for induction treatment of newly diagnosed Ph + B-ALL. Methods A retrospective analysis was performed on 24 newly diagnosed cases of Ph + B-ALL admitted to the Department of Hematology at our institution, between April 2023 and April 2025. Result The median age was 51.1 years in the blinatumomab group ( n = 11) and 42.6 years in the conventional chemotherapy group ( n = 13). All 24 patients attained CR after one cycle of induction chemotherapy. The MRD negativity rate showed a trend toward improvement in the blinatumomab group compared with the conventional chemotherapy group (81.8% 9/11 vs. 46.2% 6/13). The median BCR::ABL1 level was 0.10 (range: 0.00–0.56) in the blinatumomab group versus 2.13 (range: 0.25–9.21) in the conventional chemotherapy group. The mean log reduction in the BCR::ABL1 gene level in the blinatumomab group was 3.09 ± 0.95, which was greater than in the conventional chemotherapy group (1.64 ± 0.83). At a median follow-up of approximately 13.8 months, no relapses occurred in the blinatumomab group versus 5 relapses (38.5%) in the conventional group. We documented a significant improvement in 12-month disease-free survival (DFS) rate with the blinatumomab regimen (90.9%) compared to conventional chemotherapy (46.2%). Patients receiving blinatumomab experienced markedly reduced hematologic toxicity, manifested by a shorter duration of neutropenia (2.8 ± 2.4 vs. 6.2 ± 4.4 days), a lower incidence of bleeding (0% vs. 53.8%), and a lower rate of infections (36.4% vs. 69.2%). This improved safety profile was accompanied by a significantly lower transfusion burden, as evidenced by the consumption of fewer units of platelets (1.61 ± 1.63 vs. 4.33 ± 2.90) and red blood cells (2.14 ± 2.07 vs. 6.15 ± 4.85). Conclusion Blinatumomab combined with low-dose chemotherapy and TKIs demonstrated a trend toward improved MRD negativity, lower relapse rates, and reduced hematologic toxicity compared to conventional chemotherapy. These findings support further investigation in larger trials to confirm clinical benefit.
Ping Weng (Fri,) studied this question.