blinatumomab for consolidation for AMLL and CML blast crisis
Although NCCN lists blinatumomab for induction for Ph+B-ALL adolescents and young adults without comorbidities, after which, for persistent rising MRD, it can be used as consolidation therapy. It also says that BP-CML can be treated as ALL. However, this claimant is not in the appropriate age group and has comorbidities; more importantly, it does not recommend it for consolidation, and it is being sued for consolidation. It is also to be used together with ponatinib in the note of 8/6/2024b. There is some literature supporting this consolidation approach.
Integrating blinatumomab (Blincyto) into pre-phase and consolidation chemotherapy led to improved outcomes compared with previous results reported from the HOVON-100 study (NCT01616238) among patients with newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL). Findings from the HOVON-146 study (NCT03541083) were presented at the 2024 European Hematology Association (EHA) Annual Meeting. NCCN has not taken up this approach as of yet, and cannot yet be said to meet the medical necessity – specifically, ” reasonably expected to, prevent an illness, condition, or disability”.
Urbino I, Lengliné E, Rabian F, Cerrano M, Kim R, Chevillon F, Ferrero D, Sébert M, Dhédin N, Itzykson R, Adès L, Raffoux E, Dombret H, Audisio E, Clappier E, Boissel N. Blinatumomab consolidation for adult B-cell acute lymphoblastic leukemia in first and second complete remission. Blood Adv. 2024 May 28;8(10):2405-2409.
Blinatumomab added to prephase and consolidation therapy in precursor B-acute lymphoblastic leukemia in adults. (HOVON146ALL). ClinicalTrials.gov. Updated July 13, 2023. Accessed June 14, 2024. https://clinicaltrials.gov/study/NCT03541083 https://www.targetedonc.com/view/blinatumomab-improves-outcomes-in-b-cell-acute-lymphoblastic-leukemia
NCCN ALL and CML-4, 2024