Anderson Matheus Pereira da Silva, Luciano Falcão Carneiro Filho, Mariana Lee Han, Isabelle Rodrigues Menezes, Elizabeth Honorato de Farias, Marianna Leite, Maria da Vitória Santos do Nascimento, Eryvelton de Souza Franco, Maria Bernadete de Sousa Maia
{"title":"布利纳单抗与化疗对b细胞急性淋巴细胞白血病首次复发诱导后巩固：随机临床试验的系统回顾和荟萃分析","authors":"Anderson Matheus Pereira da Silva, Luciano Falcão Carneiro Filho, Mariana Lee Han, Isabelle Rodrigues Menezes, Elizabeth Honorato de Farias, Marianna Leite, Maria da Vitória Santos do Nascimento, Eryvelton de Souza Franco, Maria Bernadete de Sousa Maia","doi":"10.1016/j.clml.2025.05.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains a therapeutic challenge, particularly in children, adolescents, and young adults. Blinatumomab, a bispecific T-cell engager targeting CD19-positive leukemic cells, has emerged as an alternative to conventional chemotherapy in post-induction consolidation. This meta-analysis aimed to evaluate its impact on survival outcomes, relapse rates, and treatment-related toxicities.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing blinatumomab to chemotherapy as post-induction consolidation therapy in children, adolescents, and young adults with first relapse of standard-risk B-ALL were included. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Secondary outcomes included cumulative incidence of relapse, measurable residual disease (MRD) negativity, hematopoietic stem cell transplantation (HSCT) eligibility, and treatment-related toxicities. Effect sizes were estimated using hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Four RCTs including 703 patients were analyzed. Blinatumomab was associated with improved disease-free survival (DFS) (HR 0.59; 95% CI, 0.42-0.81) and OS (HR 0.57; 95% CI, 0.43-0.76), as well as a lower cumulative incidence of relapse (HR 0.26; 95% CI, 0.16-0.41). Referral for HSCT was more frequent in the blinatumomab group (RR 1.43; 95% CI, 1.10-1.85). Furthermore, blinatumomab was associated with a higher rate of measurable residual disease (MRD) negativity at the end of the first consolidation cycle (RR 1.96; 95% CI, 1.40-2.76).</p><p><strong>Conclusion: </strong>Blinatumomab improved survival outcomes and increased the proportion of patients referred for HSCT, supporting its role as post-induction consolidation therapy for relapsed B-ALL in paediatric and young adult populations.</p>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Blinatumomab Versus Chemotherapy for Post-Induction Consolidation in First Relapse of B-Cell Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.\",\"authors\":\"Anderson Matheus Pereira da Silva, Luciano Falcão Carneiro Filho, Mariana Lee Han, Isabelle Rodrigues Menezes, Elizabeth Honorato de Farias, Marianna Leite, Maria da Vitória Santos do Nascimento, Eryvelton de Souza Franco, Maria Bernadete de Sousa Maia\",\"doi\":\"10.1016/j.clml.2025.05.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains a therapeutic challenge, particularly in children, adolescents, and young adults. Blinatumomab, a bispecific T-cell engager targeting CD19-positive leukemic cells, has emerged as an alternative to conventional chemotherapy in post-induction consolidation. This meta-analysis aimed to evaluate its impact on survival outcomes, relapse rates, and treatment-related toxicities.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing blinatumomab to chemotherapy as post-induction consolidation therapy in children, adolescents, and young adults with first relapse of standard-risk B-ALL were included. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Secondary outcomes included cumulative incidence of relapse, measurable residual disease (MRD) negativity, hematopoietic stem cell transplantation (HSCT) eligibility, and treatment-related toxicities. Effect sizes were estimated using hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Four RCTs including 703 patients were analyzed. Blinatumomab was associated with improved disease-free survival (DFS) (HR 0.59; 95% CI, 0.42-0.81) and OS (HR 0.57; 95% CI, 0.43-0.76), as well as a lower cumulative incidence of relapse (HR 0.26; 95% CI, 0.16-0.41). Referral for HSCT was more frequent in the blinatumomab group (RR 1.43; 95% CI, 1.10-1.85). Furthermore, blinatumomab was associated with a higher rate of measurable residual disease (MRD) negativity at the end of the first consolidation cycle (RR 1.96; 95% CI, 1.40-2.76).</p><p><strong>Conclusion: </strong>Blinatumomab improved survival outcomes and increased the proportion of patients referred for HSCT, supporting its role as post-induction consolidation therapy for relapsed B-ALL in paediatric and young adult populations.</p>\",\"PeriodicalId\":10348,\"journal\":{\"name\":\"Clinical Lymphoma, Myeloma & Leukemia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-05-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Lymphoma, Myeloma & Leukemia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.clml.2025.05.004\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Lymphoma, Myeloma & Leukemia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clml.2025.05.004","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Blinatumomab Versus Chemotherapy for Post-Induction Consolidation in First Relapse of B-Cell Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Background: Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains a therapeutic challenge, particularly in children, adolescents, and young adults. Blinatumomab, a bispecific T-cell engager targeting CD19-positive leukemic cells, has emerged as an alternative to conventional chemotherapy in post-induction consolidation. This meta-analysis aimed to evaluate its impact on survival outcomes, relapse rates, and treatment-related toxicities.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing blinatumomab to chemotherapy as post-induction consolidation therapy in children, adolescents, and young adults with first relapse of standard-risk B-ALL were included. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Secondary outcomes included cumulative incidence of relapse, measurable residual disease (MRD) negativity, hematopoietic stem cell transplantation (HSCT) eligibility, and treatment-related toxicities. Effect sizes were estimated using hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI).
Results: Four RCTs including 703 patients were analyzed. Blinatumomab was associated with improved disease-free survival (DFS) (HR 0.59; 95% CI, 0.42-0.81) and OS (HR 0.57; 95% CI, 0.43-0.76), as well as a lower cumulative incidence of relapse (HR 0.26; 95% CI, 0.16-0.41). Referral for HSCT was more frequent in the blinatumomab group (RR 1.43; 95% CI, 1.10-1.85). Furthermore, blinatumomab was associated with a higher rate of measurable residual disease (MRD) negativity at the end of the first consolidation cycle (RR 1.96; 95% CI, 1.40-2.76).
Conclusion: Blinatumomab improved survival outcomes and increased the proportion of patients referred for HSCT, supporting its role as post-induction consolidation therapy for relapsed B-ALL in paediatric and young adult populations.
期刊介绍：
Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
