Abbreviations
ALL Acute Lymphoblastic Leukemia
HSCT Hematopoietic Stem Cell Transplantation
R/R ALL Relapsed/Refractory Acute Lymphoblastic Leukemia
MRD Minimal Residual Disease
HITO Hospital Infantil Teletón de Oncología
Introduction
Acute Lymphoblastic Leukemia (ALL) is the leading cause of cancer in the
pediatric population in Mexico.1,2 A significant
percentage of these patients drop out of treatment, being this and
relapses the most common cause of treatment failure. The intensification
of conventional chemotherapy has improved the survival of patients with
ALL; however, it involves a high rate of toxicity and
death.3 Significant advances in targeted immunotherapy
and molecular therapeutics, as well as in risk stratification for
therapy based on germline somatic genetic analysis and minimal residual
disease (MRD) monitoring, have enabled the development of targeted and
effective immunotherapies in its treatment, managing to reduce the
intensity and toxicity associated with conventional chemotherapy.4,5,6 Blinatumomab is a low-toxicity immunotherapy,
but it does not maintain prolonged remissions;7 while
Hematopoietic Stem Cell Transplantation is a cellular immunological
treatment that allows more prolonged
remissions.8,9,10,11.
The administration of Blinatumomab before HSCT reduces MRD, and has
favorable results in leukemia-free survival, toxicity, and overall
survival. It provides a complete response rate of up to 40% in second
or third relapses and contributes substantially to long-term remission
of the disease, proving to be a useful treatment alternative in patients
with R/R ALL. 12, 13, 14,15,16,17.