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Inotuzumab Ozogamicin and Low-Intensity Chemotherapy in Older Patients With Newly Diagnosed CD22 + Philadelphia Chromosome-Negative B-Cell Precursor Acute Lymphoblastic Leukemia.

Authors :
Chevallier P
Leguay T
Delord M
Salek C
Kim R
Huguet F
Hicheri Y
Wartiovaara-Kautto U
Raffoux E
Cluzeau T
Balsat M
Roth-Guepin G
Tavernier E
Lepretre S
Bilger K
Bergugnat H
Berceanu A
Alexis M
Doubek M
Brissot E
Hunault-Berger M
Lebon D
Turlure P
Chantepie S
Belhabri A
Wickenhauser S
Bastie JN
Cacheux V
Himberlin C
Banos A
Gardin C
Bonnet S
Plantier I
Pica GM
Escoffre-Barbe M
Boissel N
Dombret H
Clappier E
Rousselot P
Source :
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2024 Oct 17, pp. JCO2400490. Date of Electronic Publication: 2024 Oct 17.
Publication Year :
2024
Publisher :
Ahead of Print

Abstract

Purpose: The use of inotuzumab ozogamicin (InO), a conjugated anti-CD22 monoclonal antibody, is becoming a promising frontline treatment for older patients with ALL.<br />Patients and Methods: EWALL-INO is an open-label prospective multicenter phase II trial (ClinicalTrials.gov identifier: NCT03249870). Patients age 55 years and older with newly diagnosed CD22 <superscript>+</superscript> Philadelphia chromosome-negative (Ph-) B-cell precursor (BCP) ALL were eligible. After a prephase, a first induction consisting of vincristine, dexamethasone, and three injections of InO (0.8 mg/m <superscript>2</superscript> day 1, 0.5 mg/m <superscript>2</superscript> day 8/day 15) was followed by a second induction combining cyclophosphamide, dexamethasone, and two injections of InO (0.5 mg/m <superscript>2</superscript> day 1/day 8). Responders received up to six cycles of chemotherapy consolidation and 18-month chemotherapy maintenance. Allotransplant was allowed after three consolidations. The primary end point was 1-year overall survival (OS).<br />Results: Between December 2017 and March 2022, 131 patients (median age 68 years) were included. Three patients died during induction 1 (n = 130), two from multiple organ failure and one from hemorrhage, and none during induction 2 (n = 120). After induction 2, 90% of the patients achieved complete remission (CR) or CR with incomplete platelet recovery (CRp) and 80% had measurable residual disease (MRD2) <10 <superscript>-4</superscript> . Among responders (n = 119), 47 relapsed and 14 died in CR/CRp. One-year OS, relapse-free survival (RFS), and cumulative incidence of relapse (CIR) rates were 73.2%, 66%, and 25%, respectively. High-risk cytogenetics and lower CD22 expression (<70%) were associated with worse OS, while both high-risk cytogenetics and MRD2 ≥10 <superscript>-4</superscript> were associated with lower RFS and higher CIR. The 10 allotransplanted patients had very favorable outcomes (90% 2-year OS/RFS and no relapse). Only one nonfatal sinusoidal obstructive syndrome was documented during the study.<br />Conclusion: Our results support InO's use in first-line regimens for older patients with CD22 <superscript>+</superscript> Ph- BCP-ALL.

Details

Language :
English
ISSN :
1527-7755
Database :
MEDLINE
Journal :
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Publication Type :
Academic Journal
Accession number :
39418626
Full Text :
https://doi.org/10.1200/JCO.24.00490