1. Introduction Case Report Conclusion
The impact Blinatumomab administration prior allogeneic stem cell transplantation on the long term outcome post allografting
AlShaibani Eshrak, Attia Mohammad, Alabdulbaqi Μanar, Abduljalil Omar, Mokhtar Nihad, Kawari Mohammed, Suhebeh Ashraf, Reem Apostolidis John, Al Anazi Khalid, Al Hashmi Hani, Kaloyannidis Panayotis
Adults Hematology and Stem Cell Transplantation Department.
King Fahad Specialist Hospital Dammam, Saudi Arabia.
Introduction
Course of Blinatumab:
Before Blinatumomab:
- Left ventricle ejection fraction (LVEF) of 35%.
- Start on treatment with beta-blocker.
- Well tolerated Blinatumomab without any further cardiac complications.
During Blinatumab:
- No cytokine-released syndrome or neurotoxicity
were observed (Phenyntoin was given as prophlaxsis).
- Grade III febrile infection(resolved after broad-
spectrum antibiotics administration).
Post Blinatumab:
- Achieved CR2 with MRD negativity.
- Proceed to allogeneic stem cell transplantation.
Course of transplantation:
- Full-matched sibling donor.
- Reduced intensity regimen (RIC regimen).
- The GvHD prophylaxis:
Cyclosporine ( day -1)
Mycophenolate Mofetil (days +1 to +45)
- Engraftment
Neutrophils >500/mm3
Platelets >25000/mm3
- continous full chimeric study from day 30.
- Complication:
• Skin acute-GvHD grII Day20..
• Clost.Difficile infection Day60
• CMV-reactivation.
- Immune recovery
• B- cell recovery
• T-cell recovery
• Immunoglobulins normal levels (9 months).
Blinatumomab, a bispe­cific CD19-directed CD-3 T-cell engager has produced remarkable responses in various B-cell malignancies, mainly for patients with refractory/relapsed acute lymphoblastic leukemia (ALL) but also in patients with refractory and heavily pretreated B-cell lymphomas.
Though it is well established its reliability as a bridge to allogeneic stem cell transplantation (alloSCT), there is lack of data regarding its effect on the long-term outcome post alloSCT.
Case Report
Gender Male
Age years
Disease ALL
Induction treatment Pediatric chemotherapy protocol (CCG1961)
Response CR
Relapse months
1st Salvage Hyper-CVAD
Response salvage Refractory
2nd salvage Blinatumomab
Route hours infusion
Dose mcg and reaching after a week, the maximum dose of 28mcg/m2
Response CR2
20 DAYS
Conclusion
• Blinatumomab found to be effective in terms of disease control before alloSCT. .
• Showed a safe profile during the early and long-term post alloSCT period, not adversely affecting the engraftment, immune reconstitution
and infections incidence..