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Blinatumomab for Acute Lymphoblastic Leukemia: Clinical Pharmacology and Therapeutic Results

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Chemotherapy for Leukemia

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Abstract

Blinatumomab, a bispecific CD19/CD3 T-cell engager (BiTE), is a genetically engineered single-stranded bispecific monoclonal antibody. It consists of mouse monoclonal variant chains that bind to CD19 at the N-terminus and to CD3 at the C-terminus. Since many cases of B-lineage acute lymphoblastic leukemia (B-ALL) express CD19 on the leukemic cells, blinatumomab can associate B-ALL leukemic cells with T cells and form immune synapses between them, which result in T-cell activation and proliferation. Thereafter, the leukemic cells are killed by perforin-mediated cell lysis.

Blinatumomab can induce complete remission (CR) in 40–60% of cases of relapsed/refractory B-cell precursor (B-precursor) ALL, and 40–60% of CR patients become minimal residual disease (MRD) negative. Blinatumomab is effective for patients who have recurred after chemotherapy and after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The characteristic adverse effects of this drug are central nervous system disorders (tremor, dizziness, confusion, encephalopathy, ataxia, aphasia) and cytokine releasing syndromes (flu-like symptoms, hypotension pulmonary edema, multi-organ failure). The efficacy of blinatumomab for de novo B-precursor ALL patients and in combination therapies with other anticancer drugs has not been investigated.

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Authors and Affiliations

  1. Leukemia Research Center, Saiseikai Maebashi Hospital, 564-1 Kamishindenmachi, Maebashi, Gunma, 371-0821, Japan

    Satoru Takada

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  1. Satoru Takada
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Correspondence to Satoru Takada .

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  1. University of Fukui, Fukui, Japan

    Takanori Ueda

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Takada, S. (2017). Blinatumomab for Acute Lymphoblastic Leukemia: Clinical Pharmacology and Therapeutic Results. In: Ueda, T. (eds) Chemotherapy for Leukemia. Springer, Singapore. https://doi.org/10.1007/978-981-10-3332-2_8

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  • DOI: https://doi.org/10.1007/978-981-10-3332-2_8

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