Hematology · 2 h ago
Pre-blinatumomab flow MRD predicts survival in Ph+ B-ALL
In a retrospective multicenter study of 81 adults with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia, detectable flow-cytometry MRD before blinatumomab consolidation was associated with worse survival—even after patients achieved MRD-negative remission. The association was not seen in an exploratory subgroup that received hematopoietic cell transplantation in first remission.
- Pre-blinatumomab flow MRD positivity was linked to worse survival.
- Association persisted despite subsequent MRD-negative remission.
- Transplant subgroup findings were exploratory.
Researchers retrospectively studied 81 adults with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia (Ph+ B-ALL) who were in measurable residual disease (MRD)-negative first complete remission after blinatumomab consolidation. They compared outcomes by multiparametric flow-cytometry MRD status before consolidation: 56 patients were MRD-negative and 25 were MRD-positive. Median follow-up was 31 months.
Compared with patients who were MRD-positive before blinatumomab, those who were MRD-negative had better disease-free survival (adjusted hazard ratio, 0.27; 95% CI, 0.08–0.87) and overall survival (adjusted hazard ratio, 0.17; 95% CI, 0.03–0.90). IKZF1-plus genotype and extramedullary disease at diagnosis were also associated with inferior disease-free survival. In exploratory analyses, pre-consolidation MRD positivity remained associated with worse outcomes among patients who did not undergo hematopoietic cell transplantation (HCT) in first remission, but not among those who did.
The findings suggest that MRD status before blinatumomab may carry prognostic information even after subsequent MRD clearance. The retrospective design and exploratory transplant subgroup analysis limit conclusions about whether HCT modifies this association; the results do not establish a treatment strategy.
In practice
For adults with Ph+ B-ALL in first remission after blinatumomab consolidation, detectable flow-cytometry MRD before consolidation was associated with inferior disease-free and overall survival despite later MRD-negative status. This may provide prognostic context, but the retrospective study does not show that changing treatment based on this finding improves outcomes. The apparent lack of association among patients receiving HCT in first remission comes from exploratory subgroup analyses and does not establish a transplant benefit.
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Blood Advances: Flow MRD pre-blinatumomab consolidation, despite subsequent clearance, is associated with inferior survival in Ph+ B-ALL ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.