Blinatumomab Versus Chemotherapy for Post-Induction Consolidation in First Relapse of B-Cell Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract

Background: Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains a therapeutic challenge, particularly in children, adolescents, and young adults. Blinatumomab, a bispecific T-cell engager targeting CD19-positive leukemic cells, has emerged as an alternative to conventional chemotherapy in post-induction consolidation. This meta-analysis aimed to evaluate its impact on survival outcomes, relapse rates, and treatment-related toxicities.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing blinatumomab to chemotherapy as post-induction consolidation therapy in children, adolescents, and young adults with first relapse of standard-risk B-ALL were included. Primary outcomes were disease-free survival (DFS) and overall survival (OS). Secondary outcomes included cumulative incidence of relapse, measurable residual disease (MRD) negativity, hematopoietic stem cell transplantation (HSCT) eligibility, and treatment-related toxicities. Effect sizes were estimated using hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI).

Results: Four RCTs including 703 patients were analyzed. Blinatumomab was associated with improved disease-free survival (DFS) (HR 0.59; 95% CI, 0.42-0.81) and OS (HR 0.57; 95% CI, 0.43-0.76), as well as a lower cumulative incidence of relapse (HR 0.26; 95% CI, 0.16-0.41). Referral for HSCT was more frequent in the blinatumomab group (RR 1.43; 95% CI, 1.10-1.85). Furthermore, blinatumomab was associated with a higher rate of measurable residual disease (MRD) negativity at the end of the first consolidation cycle (RR 1.96; 95% CI, 1.40-2.76).

Conclusion: Blinatumomab improved survival outcomes and increased the proportion of patients referred for HSCT, supporting its role as post-induction consolidation therapy for relapsed B-ALL in paediatric and young adult populations.

Keywords: Disease-free survival; Hematopoietic stem cell transplantation; Immunotherapy; measurable residual disease.