Discussion
Acute lymphoblastic leukemia is the most common type of cancer in
children and unfortunately, about 15% of children with high-risk B-ALL
relapse after chemotherapy treatment, so there is a need for new
treatment options for these patients.18 Blinatumomab
is an adequate bridge therapy to consolidate with transplantation in
these patients, since it has been shown to be more effective and is
associated with a lower number of toxicities and less severe
complications, compared to intensive chemotherapy, allowing to obtain
favorable hematological conditions for the performance of a transplant
in terms of complete remission and residual disease, with satisfactory
clinical tolerance, however, it is a treatment of high cost and
difficult access for developing countries, such as Mexico. This series
of patient cases represents a clear example of this situation. HITO is
the unique specialized pediatric cancer hospital in Mexico. It was
inaugurated in 2013 and began offering the HSCT service in 2014. At the
beginning the number of HSCT procedures were approximately 4 to 5 per
year. Through the years, this has been changing for the better, growing
and improving the quality of care, allowing us to offer HSCT services to
more patients. In 2019, the opportunity arises to introduce blinatumomab
as a treatment in our institution. Nine patients were included in the
present study. Comparing our results with other series is difficult;
mainly because of the number of patients and because we do not randomize
them. However, comparing the overall survival of these patients with
those who do not have access to blinatumomab, as is the case with most
of the patients in developing countries, the use of blinatumomab gives
us a better prognosis and clearly a statistically better incentive for
our country and institution. Probably all patients with positive MRD
would have died. The international literature describes an overall
survival of 2 years with blinatumomab use of 71. 3% versus 58.4%
without the use of it.19