Outcome of relapsed or refractory acute B-lymphoblastic leukemia patients and <i>BCR-ABL</i>-positive blast cell crisis of B-lymphoid lineage with extramedullary disease receiving inotuzumab ozogamicin
Sabine Kayser,
Chiara Sartor,
Marlise R. Luskin,
Jonathan Webster,
Fabio Giglio,
Nydia Panitz,
Andrew M. Brunner,
Matthias Fante,
Christoph Lutz,
Daniel Wolff,
Anthony D. Ho,
Mark J. Levis,
Richard F. Schlenk,
Cristina Papayannidis
Affiliations
Sabine Kayser
Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany; NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg
Chiara Sartor
Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna
Marlise R. Luskin
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
Jonathan Webster
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
Fabio Giglio
Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan
Nydia Panitz
Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig
Andrew M. Brunner
Massachusetts General Hospital, Boston, MA
Matthias Fante
Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg
Christoph Lutz
Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany; Praxis for Hematology and Oncology Koblenz, Koblenz
Daniel Wolff
Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg
Anthony D. Ho
Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
Mark J. Levis
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
Richard F. Schlenk
NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
Cristina Papayannidis
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli” Bologna
Acute lymphoblastic leukemia (ALL) can relapse in the extramedullary compartment, with or without medullary involvement. Response to treatment may be individual. We evaluated response to inotuzumab ozogamicin in 31 patients with relapsed/refractory B-ALL with extramedullary disease. Median age was 31 years (range, 19-81). All patients were heavily pretreated, including allogeneic hematopoietic stem cell transplantation (HSCT; n=18). Overall response rate after two cycles of inotuzumab ozogamicin was 84% (complete remission, 55%; partial remission, 29%; resistant disease, 13%; early death, 3%). The median follow-up was 29 months and median overall survival was 12.8 months. One-year and 2-year overall survival rates were 53% (95% CI: 37-76%) and 18% (95% CI: 8-43%), respectively. Age had no impact on overall survival when assessed as a continuous variable or dichotomized at 60 years. Twelve patients proceeded to allogeneic HSCT (complete remission, n=6; partial remission, n=3; resistant disease, n=3). Prior to allogeneic HSCT, eight patients received two or fewer cycles and four patients received three or four cycles of inotuzumab ozogamicin. Sinusoidal obstruction syndrome was reported in three patients, including one after transplantation. Allogeneic HSCT, evaluated as a time-dependent variable, had no impact on overall survival. Inotuzumab ozogamicin seems to be effective as a debulking strategy in relapsed/refractory ALL with extramedullary disease. However, inotuzumab ozogamicin followed by allogeneic HSCT seems not to be effective in maintaining long-term disease control.
