Comparison of blinatumomab and CAR T-cell therapy in relapsed/refractory acute lymphoblastic leukemia: a systematic review and meta-analysis

This study evaluated the benefits and risks of patients with refractory or relapsed acute lymphocytic leukemia (R/R ALL) treated with anti-CD19 chimeric antigen receptor (CAR) T-cell therapy and blinatumomab. PubMed, Web of Science, Embase, and the Cochrane Library were searched for relevant studies. The pooled complete remission (CR) rate and minimal residual disease (MRD) negative rate were 48%, 31% for blinatumomab, and 86% and 80% for CAR T-cell therapy. The CAR T-cell therapy group exhibited a higher likelihood of CR rate than the blinatumomab group in every analysis regardless of adjustment subgroups. CAR T-cell therapy was associated with a significantly prolonged overall survival (OS) and relapse-free survival (RFS) compared with blinatumomab (2-year OS 55% vs 25%; 2-year RFS 40% vs 22%). CAR T-cell therapy was more effective for achieving CR and bridging to allogeneic hematopoietic stem cell transplantation (allo‐SCT) than blinatumomab (2-year OS 75% vs. 57%). An emerging role for blinatumomab is as a bridging agent pre-SCT, and for patients who achieve an MRD-negative state pre-SCT, post-SCT outcomes are expected to be the same as CAR-T. For adverse effects (AEs), blinatumomab was associated with a lower rate of grade ≥3 hematological toxicity, CRS, and neurological events.本研究评估了复发难治性急性淋巴细胞白血病（R/R ALL）患者接受抗CD19嵌合抗原受体（CAR）T细胞疗法与贝林妥欧单抗（blinatumomab）治疗的获益与风险。研究团队检索了PubMed、Web of Science、Embase及Cochrane Library数据库中的相关研究。合并分析结果显示，贝林妥欧单抗组的完全缓解（CR）率与微小残留病（MRD）阴性率分别为48%与31%，CAR T细胞疗法组则分别为86%与80%。无论校正亚组划分方式如何，所有分析均表明CAR T细胞疗法组的完全缓解率显著高于贝林妥欧单抗组。相较于贝林妥欧单抗，CAR T细胞疗法可显著延长患者的总生存期（OS）与无复发生存期（RFS），其中2年总生存率分别为55% vs 25%，2年无复发生存率分别为40% vs 22%。在实现完全缓解并桥接异基因造血干细胞移植（allo‐SCT）方面，CAR T细胞疗法同样更具优势，二者2年总生存率分别为75% vs 57%。贝林妥欧单抗的新兴应用场景为造血干细胞移植前的桥接治疗，且对于移植前达到微小残留病阴性状态的患者，其移植后结局与CAR T细胞疗法相当。在不良反应（AEs）方面，贝林妥欧单抗的≥3级血液学毒性、细胞因子释放综合征（CRS）及神经系统不良事件发生率均更低。