Alpha/Beta T-cell and B-cell Depleted Allogeneic Transplantation (IDE 13641) Followed by Blinatumomab Therapy for High-Risk B-Acute Lymphoblastic Leukemia: A Pilot Study
Summary
This trial will assess the feasibility of alpha/beta T-cell and B-cell depleted allogeneic hematopoietic cell transplantation (HCT) followed by blinatumomab therapy for high-risk B cell acute lymphoblastic leukemia (ALL) as a means of reducing rates of subsequent relapse and improving survival, while also minimizing treatment-related morbidity/ mortality and late effects. The conditioning regimens will be dependent on the patient's minimal residual disease (MRD) status prior to HCT using high throughput sequencing.
Detailed description
This trial evaluates the ability of a biologically active therapy in blinatumomab, an anti-CD19/CD3 bispecific T-cell engager, to further reduce the risk of leukemia relapse following HCT to improve post-HCT outcomes. The investigators will also utilize an alpha-beta T-cell and B-cell depleted graft to reduce the risk of GVHD along with a reduced intensity conditioning regimen without the use of TBI in patients who are minimal residual disease (MRD) negative using high throughput sequencing (HTS) prior to HCT. For those patients who remain HTS-MRD positive, a myeloablative conditioning regimen will be utilized, also followed by blinatumomab. This multi-institutional pilot study will be limited to 25 (estimated 10-15 per stratum) evaluable children, adolescents and young adults with B-ALL, that have experienced a relapse or have high-risk disease.
Arms & interventions
- DeviceAlpha/Beta T-cell and B-cell depleted HCT
Device: Alpha/Beta T-cell and B-cell depletion
- DrugBlinatumomab
28 day continuous infusion given on Day 100 post-HCT if no significant ongoing GVHD
Outcome measures
Primary
Percentage of patients who are able to receive the blinatumomab infusion [Feasibility]
Percentage of patients who are able to receive the blinatumomab infusion at day +100 post-HCT and complete a minimum of 14/28 planned days
Time frame: Day +100 post-HCT
Secondary
Cumulative incidence of treatment-related adverse events [Tolerability]
Time frame: Day of HCT to Day +180 post-HCT
Overall Survival
Time frame: Day of HCT to 1 year post-HCT
Disease Free Survival
Time frame: Day of HCT to 1 year post-HCT
Engraftment
Time frame: Day +100 and +1 year post-HCT
Primary Graft Failure
Time frame: Day +28 and + 1 year post-HCT
Secondary Graft Failure
Time frame: Day +28 and +1 year post-HCT
Treatment Related Mortality
Time frame: Day of HCT to Day +100 and 1 year post-HCT
Acute & Chronic GVHD
Time frame: Day +100, +180 and 1 year post-HCT
Patient Reported Outcomes
Time frame: Baseline, Day +100, +180, +1 year post-HCT
Length of Stay
Time frame: Number of days between the day of transplantation, Day 0, and Day +180 post-HCT
Persistence of Minimal Residual Disease (MRD) Negativity
Time frame: Days +28, +100, +180 and +1 year post-HCT
Relapse
Time frame: Day of HCT to day +180 and 1 year post-HCT
Eligibility criteria
Study locations (1)
Children's Hospital of Wisconsin
Milwaukee, Wisconsin, 53226
References
- Davis KL, Yao CC, Zimmerman JAO, Rau RE. Immunotherapy in B-Cell Acute Lymphoblastic Leukemia. J Natl Compr Canc Netw. 2025 Dec;23(12):e257067. doi: 10.6004/jnccn.2025.7067.(PubMed)