Adding blinatumomab to consolidation therapy in the treatment of younger adults with B-ALL: subgroup data from ECOG-ACRIN E1910

In the pivotal E1910 trial, adult (30-70 years) patients with B-cell acute lymphoblastic leukemia (B-ALL) with measurable residual disease (MRD) negativity after induction and intensification therapy were randomly assigned to consolidation chemotherapy with or without blinatumomab. The chemotherapy regimen that was used in this trial was an adaptation of the UKALLXII/E2993 adult chemotherapy regimen with dose modifications from the pediatric inspired CALGB 10403 trial. Previously, it was shown that the addition of blinatumomab to consolidation therapy significantly improved the overall survival (OS) of patients. During EHA 2025, Dr Shira Dinner, hematologist at the Robert H Lurie Comprehensive Cancer Center in Chicago presented the results of a subgroup analysis of this trial specifically looking at patients below 55 years of age. 

Overall, 277 of the 488 patients enrolled in E1910 were younger than 55 years old. The median age of this ‘younger’ cohort was 42 years and 53% had a high combined molecular risk. In total 86% of these patients achieved a complete response with (CR) or without (CRi) count recovery after induction of whom 132 were MRD-negative. Subsequently, 66 patients were randomized to consolidation chemotherapy + blinatumomab, while the remaining 66 only received consolidation chemotherapy. Three-year OS rates for these patients were reported at 92% in the blinatumomab-chemotherapy arm as compared to 67% with chemotherapy alone (HR[95%CI]: 0.20[0.08-0.54]; p=0.002). At 3 years, 86% of blinatumomab-chemotherapy treated patients were relapse free while this was the case for 66% of patients in the control arm (HR[95%CI]: 0.37[0.17-0.81]; p= 0.01).

Of the 102 patients aged 30-39 years, 87 achieved CR/CRi. Of them, 47 were MRD-negative and were subsequently randomized. Of note, 29% of the patients in this cohort who were randomized to blinatumomab-chemotherapy had high molecular risk disease, while this was only the case for 15% in the chemotherapy alone arm. At 3 years, all patients in the blinatumomab-chemotherapy arm were still alive as compared to 73% in the chemotherapy alone arm (p=0.009). Corresponding 3-year relapse-free survival (RFS) rates were 90% and 69%, respectively (p=0.03).

Based on these findings, Dr Dinner concludes that blinatumomab should be incorporated into the care of all adolescents and young adults with B ALL.