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.