Oriana López‐Godino

Chimeric antigen receptor (CAR) T cells targeting CD19 have changed the treatment landscape of patients with relapsed/refractory diffuse large B-cell lymphoma. Infections are one of the most freque... Plain language summary Lymphoma is an aggressive blood cell cancer. A treatment called chimeric antigen receptor (CAR) T-cell therapy has recently been developed for patients with lymphoma and othe...

Introduction: The prognosis of relapsed B cell precursor acute lymphoblastic leukemia (B‐ALL) is poor and few patients can be successfully rescued with conventional therapies. Inotuzumab ozogamicin (IO), an antibody against the CD22 antigen linked to calicheamicin, has been approved as a rescue treatment in relapsed/refractory (R/R) B‐ALL.Patients and Methods: This was an observational, retrospective, multicenter study of adult patients included in the Spanish program of compassionate use of IO in centers from the PETHEMA group (Programa Español de Tratamientos en Hematología).Results: Thirty‐four patients with a median age of 43 years (range, 19–73) were included. Twenty patients (59%) were refractory to the last treatment, IO treatment was given as ≥3rd salvage treatment in 25 patients (73%) and 20 patients (59%) received allogeneic hematopoietic stem cell transplantation before IO treatment. After a median of 2 cycles of IO, 64% of patients achieved complete response (CR)/complete response with incomplete recovery. The median response duration, progression‐free survival and overall survival (OS) were 4.7 (95%CI, 2.4–7.0 months), 3.5 (95%CI, 1.0–5.0 months) and 4 months (95%CI, 1.9–6.1 months) respectively, with better OS for patients with relapsed B‐ALL versus refractory disease (10.4 vs. 2.5 months, respectively) (p = .01). There was a trend for better OS for patients with first CR duration >12 months (7.2 months [95%CI, 3.2–11.2] vs. 3 months [95% CI, 1.8–4.2] respectively) (p = .054). There was no sinusoidal obstruction syndrome (SOS) event during IO treatment, but three patients (9%) developed grade 3–4 SOS during alloHSCT after IO treatment.Conclusions: Our study showed slightly inferior outcomes of the pivotal trial probably due to poorer risk factors and late onset of IO therapy of recruited patients. Our results support early use of IO in relapsed/refractory ALL patients.

The outcomes of patients with acute lymphoblastic leukaemia (ALL) presenting relapse after allogeneic stem cell transplant (allo‐SCT) are poor, with few data available in this setting.Objective and Methods: To evaluate the outcomes of patients with ALL presenting relapsed after allo‐SCT, we performed a retrospective study including 132 from 11 centres in Spain.Results: Therapeutic strategies consisted of palliative treatment (n = 22), chemotherapy (n = 82), tyrosine kinase inhibitors (n = 26), immunotherapy with inotuzumab and/or blinatumumab (n = 19), donor lymphocyte infusions (n = 29 pts), second allo‐SCT (n = 37) and CAR T therapy (n = 14). The probability of overall survival (OS) at 1 and 5 years after relapse was 44% (95% confidence interval [CI]: 36%; 52%) and 19% (95% CI: 11%; 27%). In the 37 patients undergoing a second allo‐SCT, the 5‐year estimated OS probability was 40% [22%; 58%]. Younger age, recent allo‐SCT, late relapse, 1st complete remission at 1st allo‐SCT and chronic graft‐versus‐host disease confirmed their positive impact on survival in the multivariable analysis.Conclusion: Despite the poor prognosis of patients with ALL presenting relapse after a first allo‐SCT, some can be satisfactorily rescued and a second allo‐SCT still remains a valid option for selected patients. Moreover, emerging therapies really might improve ALL patients outcome when relapsing after an allo‐SCT.