Although complete remission rates in adults with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) have improved over the last 2 decades, it is still inferior to that of the pediatric population, and once in remission, the risk of relapse is still high. Furthermore, although pediatric-inspired chemotherapy regimens have improved long-term outcomes for adolescents and young adults, these intensive chemotherapy regimens are not well tolerated in older patients and are associated with higher morbidity and mortality. Immunotherapeutic agents offer a potential opportunity to improve response and decrease relapse without increasing toxicity. The incorporation of rituximab (anti-CD20 monoclonal antibody) into chemotherapy regimens has been shown to improve outcomes. The treatment of BCP-ALL in adults has been transformed with the approval of inotuzumab ozogamicin (anti-CD22 antibody-drug conjugate), blinatumomab (CD3/CD19 bispecific antibody construct), and chimeric antigen receptor T cells for relapsed or refractory disease and of blinatumomab for measurable residual disease (MRD)–positive remission. More recently, studies of inotuzumab and blinatumomab have shown promising results when used upfront either with or without multiagent chemotherapy. Blinatumomab has also been shown in a randomized trial to provide a survival benefit in patients with MRD-negative first remission when added to chemotherapy, which recently led to its additional US Food and Drug Administration approval for use in consolidation. In this review, we highlight the evolution of chemoimmunotherapy-based treatment approaches in the management of treatment-naïve BCP-ALL.

中文翻译：

---

将免疫疗法纳入成人 B 细胞前体急性淋巴细胞白血病的一线治疗


尽管 B 细胞前体急性淋巴细胞白血病 （BCP-ALL） 成人患者的完全缓解率在过去 2 年中有所提高，但仍不如儿科人群，一旦缓解，复发的风险仍然很高。此外，尽管儿科启发的化疗方案改善了青少年和年轻人的长期预后，但这些强化化疗方案在老年患者中的耐受性不佳，并且与较高的发病率和死亡率相关。免疫治疗药物提供了在不增加毒性的情况下改善反应和减少复发的潜在机会。将利妥昔单抗（抗 CD20 单克隆抗体）纳入化疗方案已被证明可以改善结局。随着 inotuzumab ozogamicin（抗 CD22 抗体-药物偶联物）、blinatumomab（CD3/CD19 双特异性抗体构建体）和嵌合抗原受体 T 细胞用于复发或难治性疾病和 blinatumomab 用于可测量残留病 （MRD） 阳性缓解的批准，成人 BCP-ALL 的治疗已经发生了变化。最近，inotuzumab 和 blinatumomab 的研究显示，无论是否联合多药化疗，前期使用都显示出有希望的结果。一项随机试验还显示，在化疗中加入 Blinatumomab 时，Blinatumomab 可为 MRD 阴性首次缓解的患者提供生存获益，这导致其最近获得美国食品和药物管理局的额外批准，用于巩固治疗。在这篇综述中，我们强调了基于化学免疫疗法的治疗方法在治疗初治 BCP-ALL 中的演变。