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Complete remission after blinatumomab-induced donor T-cell activation in three pediatric patients with post-transplant relapsed acute lymphoblastic leukemia

Leukemia volume 25, pages 181–184 (2011)Cite this article

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Although post-transplant donor lymphocyte infusions might induce remissions in few patients via the induction of a graft-versus-leukemia effect,1 refractory relapse of B-precursor acute lymphoblastic leukemia (ALL) after allogeneic hematopoietic stem cell transplantation (HSCT) is associated with a dismal prognosis. Morphological disease2 or persistent minimal residual disease (MRD) levels of >10−4 leukemic blasts3 before allogeneic HSCT have been shown to be associated with a high risk of relapse after transplantation and a poor outcome. Despite the use of recently introduced chemotherapeutic agents for refractory leukemia,4 patients who relapse after allogeneic HSCT often have refractory disease and are particularly susceptible to chemotherapy-related toxicity.

T-cell engaging antibodies are a novel strategy for treatment of lymphoma and leukemia.5 Such bispecific antibodies are designed to transiently engage primed cytotoxic effector-memory T lymphocytes for the lysis of target cells. By using the T-cell engaging CD19/CD3-bispecific antibody blinatumomab, partial and complete remissions (CRs) in patients with relapsed B cell non-Hodgkin lymphomas,6 and elimination of chemorefractory residual leukemic blasts in bone marrow of the adult patients with MRD-positive B-precursor ALL were observed.7 Although in these patients with B-precursor ALL, the blinatumomab-engaged cytotoxic T cells were patient derived, blinatumomab had so far not been administered in pediatric patients or in any patients after allogeneic HSCT, a condition in which the engaged T cells are donor derived.

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Author notes

  1. R Handgretinger and G Zugmaier: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology/Oncology, Children's University Hospital, Tübingen, Germany

    R Handgretinger & P Lang

  2. Micromet AG, München, Germany

    G Zugmaier

  3. Department of Pediatric Oncology/Hematology, Charite Universitätsmedizin Berlin, Berlin, Germany

    G Henze & A von Stackelberg

  4. Department of Hematology/Oncology, Children's University Hospital, Frankfurt, Germany

    H Kreyenberg

Authors
  1. R Handgretinger
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  2. G Zugmaier
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  3. G Henze
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  4. H Kreyenberg
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  5. P Lang
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  6. A von Stackelberg
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Correspondence to R Handgretinger.

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Handgretinger, R., Zugmaier, G., Henze, G. et al. Complete remission after blinatumomab-induced donor T-cell activation in three pediatric patients with post-transplant relapsed acute lymphoblastic leukemia. Leukemia 25, 181–184 (2011). https://doi.org/10.1038/leu.2010.239

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