Blinatumomab Shows Superior Efficacy Over Chemotherapy in B-ALL Patients

In a significant advancement for the treatment of newly diagnosed BCR::ABL1-negative B acute lymphoblastic leukemia (B-ALL), data from the phase 3 E1910 trial reveal that consolidation therapy with blinatumomab, marketed as Blincyto, markedly improves overall survival (OS) and relapse-free survival (RFS) compared to traditional chemotherapy. The findings were presented at the European Hematology Association Congress held from June 12 to 15, 2025, in Milan, Italy.

The E1910 trial enrolled patients aged 30 to 54 years with newly diagnosed BCR::ABL1-negative B-ALL, who were in minimal residual disease (MRD)-negative complete response following initial treatment. Participants received either four cycles of consolidation chemotherapy alone or chemotherapy combined with four cycles of blinatumomab. According to the results, the three-year RFS rate in the blinatumomab arm was 86%, compared to 66% in the chemotherapy-only group (hazard ratio [HR] 0.37; 95% confidence interval [CI], 0.17-0.81). Furthermore, patients aged 30 to 39 years who were MRD-negative exhibited a 100% three-year OS rate with blinatumomab, contrasted with 73% for those receiving chemotherapy alone (p = 0.009).

The correlation between body mass index (BMI) and treatment outcomes was also assessed. The study found that patients with a BMI of less than 30 kg/m² experienced superior survival outcomes, with a three-year OS rate of 94% when treated with the combination therapy, compared to a 90% OS rate among those with a BMI of 30 kg/m² or greater.

The trial involved a total of 488 patients, with 37% undergoing hematopoietic cell transplant. The median age of participants was 42 years, with a demographic breakdown of 48% female and 78% White. Additionally, the molecular risk classification indicated that 18% had favorable, 16% intermediate, and 52% unfavorable disease.

Adverse events were reported, with grade 3/4 treatment-related adverse events differing between the two groups. For instance, neutrophil count decrease occurred in 80% of the blinatumomab arm versus 89% in the chemotherapy arm. Neurologic disorders were notably more prevalent in the blinatumomab group (38% vs. 11%).

Dr. Shira N. Dinner, an associate professor at the Feinberg School of Medicine at Northwestern Medicine, emphasized the importance of these findings, suggesting that blinatumomab should be integrated into the treatment protocols for all adolescents and young adults diagnosed with B-ALL. She stated, 'These results, combined with the pediatric COG AALL 1731 data, strongly support the incorporation of blinatumomab into clinical practice.'

The study's implications are significant for the treatment landscape of B-ALL, particularly in addressing the challenges associated with chemotherapy resistance and adverse effects. Future investigations are necessary to explore the potential of blinatumomab in reducing the reliance on chemotherapy and enhancing MRD negativity in patients. With an increasing focus on precision medicine, these outcomes may reshape therapeutic strategies in hematologic malignancies and improve the prognosis for this patient population.

The E1910 trial results will be pivotal as clinicians evaluate treatment options, aiming to optimize patient outcomes while minimizing the risks associated with traditional chemotherapy. Continued research into blinatumomab's efficacy and safety profile will be essential in the coming years, heralding a new era in the management of B-ALL.