INOTUZUMAB OZOGAMICIN FOR RELAPSED/REFRACTORY ACUTE LYMPHOBLASTIC LEUKEMIA – A BRIDGE TO HAPLOIDENTICAL STEM CELL TRANSPLANTATION
Keywords:
Inotuzumab ozogamicin, haploidentical stem cell transplantation, bridge to transplantAbstract
Introduction: At present, allogeneic hematopoietic stem cell transplantation (allo-HCT) is considered the only curative option for patients with R/R B-ALL with best outcomes achieved after effective salvage re-induction therapy and transplantation in complete remission (CR) without measurable residual disease (MRD). Inotuzumab ozogamicin (INO) is a CD22-directed humanized monoclonal antibody conjugated to the potent cytotoxin, calicheamicin, via an acid labile linker, which was developed as a targeted therapy for B-cell malignancies. In this paper, we present our center first experience with INO bridging treatment in R/R ALL before haploidentical stem cell transplantation.
Case presentation: We present a case of a 24-year-old female patient diagnosed as B-ALL during July 2021 at the University Clinic of Wurzburg, Germany where she initiated treatment according to German multicenter study group protocol for adult ALL (GMALL) regimen. She had disease relapse early during maintenance treatment. INO was administered in two cycles as monotherapy bridge to haploidentical transplant. The patient achieved MRD negativity and continued conditioning with thiotepa, busulfan and fludarabine. Immunosuppression was provided with posttransplant cyclophosphamide (PTCy), mycophenolate mofetil (MMF) and cyclosporine. Chimerism analysis on +1, +3, +6, +9 and +12 months post-transplant showed full chimerism with negative MRD.
Conclusion: Bridging patients safely to HSCT is the primary goal of post-relapse ALL treatment, but allo-HCT is associated with considerable treatment-related morbidity and mortality. Salvage with inotuzumab ozagamicin can provide a bridge to transplant in relapsed/refractory ALL.
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