Case Report: Blinatumomab therapy for the treatment of B-cell acute lymphoblastic leukemia patients with central nervous system infiltration

Han-Yu Cao; Hui Chen; Song-Bai Liu; Wen-Jie Gong; Chong-Sheng Qian; Tong-Tong Zhang; Chao-Ling Wan; Si-Man Huang; Nan Xu; Hai-Ping Dai; Sheng-Li Xue

doi:10.3389/fimmu.2023.1181620

Case Report: Blinatumomab therapy for the treatment of B-cell acute lymphoblastic leukemia patients with central nervous system infiltration

Front Immunol. 2023 Apr 18:14:1181620. doi: 10.3389/fimmu.2023.1181620. eCollection 2023.

Authors

Han-Yu Cao^{1

2}, Hui Chen³, Song-Bai Liu⁴, Wen-Jie Gong^{1

2}, Chong-Sheng Qian^{1

2}, Tong-Tong Zhang^{1

2}, Chao-Ling Wan^{1

2}, Si-Man Huang^{1

2}, Nan Xu⁵, Hai-Ping Dai^{1

2}, Sheng-Li Xue^{1

2}

Affiliations

¹ National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
² Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
³ Hematological Department, The First People's Hospital of Yancheng, Yancheng, China.
⁴ Suzhou Key Laboratory of Medical Biotechnology, Suzhou Vocational Health College, Suzhou, China.
⁵ Research and Development Department, Shanghai Unicar-Therapy Bio-Medicine Technology Co. Ltd, Shanghai, China.

Abstract

The treatment of B-cell acute lymphoblastic leukemia (B-ALL) with central nervous system (CNS) involvement poses a significant clinical challenge because most chemotherapeutic agents exhibit weak permeability to the blood-brain barrier (BBB). In addition, current anti-CNS leukemia treatments often bring short or long-term complications. Immunotherapy including chimeric antigen T-cell therapy and bispecific antibody have shown profound treatment responses in relapsed/refractory B-ALL. However, there is a lack of data on the efficacy of bispecific antibody in treating B-ALL with CNS involvement. Here, we report two ALL patients with CNS leukemia who received blinatumomab. Case 1 was diagnosed with chronic myeloid leukemia in lymphoid blast phase. The patient developed CNS leukemia and bone marrow relapse during the treatment with dasatinib. Case 2 was diagnosed with B-ALL and suffered early hematologic relapse and cerebral parenchyma involvement. After treatment with one cycle of blinatumomab, both patients achieved complete remission in the bone marrow and CNS. Furthermore, this is the first report on the efficacy of blinatumomab in treating CNS leukemia with both of the cerebral spinal fluid and the cerebral parenchymal involvement. Our results suggest that blinatumomab might be a potential option for the treatment of CNS leukemia.

Keywords: acute lymphoblastic leukemia; blast phase; blinatumomab; central nervous system leukemia; chronic myeloid leukemia; immunotherapy.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Agents* / therapeutic use
Central Nervous System
Humans
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
Recurrence

Substances

blinatumomab
Antineoplastic Agents

Grants and funding

This work was supported by the grants from the National Key R&D Program of China (Grant No. 2022YFC2502703), National Natural Science Foundation of China (Grant No. 81970138, 82270165, 82200249), Jiangsu Province Natural Science Foundation of China (Grant No. BK20221235, BK20210091), Translational Research Grant of NCRCH (Grant No. 2020ZKMB05), Jiangsu Province “333” Project, Social Development Project of the Science and Technology Department of Jiangsu (Grant No. BE2021649), Jiangsu higher education institution innovative research team for science and technology (2021), The Open Project of Jiangsu Biobank of Clinical Resources (Grant No. TC2021B009), Bethune Charitable Foundation (Grant No. BCF-IBW-XY-20220930-08) and Gusu Key Medical Talent Program (Grant No. GSWS2019007).