ASH 2024: Leukemia Biology Can Predict Patterns of Blinatumomab Failure in Patients with B-Cell ALL

In an interview with Pharmacy Times®, Jose Tinajero, hematology clinical pharmacist at City of Hope Cancer Treatment Center in Duarte, California, highlights new data regarding blinatumomab (Blincyto; Amgen) responsiveness and indicators of relapse from a retrospective trial set to be presented at the 66th American Society of Hematology Annual Meeting and Exposition.

The study found that patients with TP53 mutations had an increased risk of CD19-negative relapse, suggesting that leukemia biology can predict relapse patterns. Tinajero discusses the implications of these findings for the future development of targeted therapies for B-ALL, emphasizing that certain features may influence relapse. He also elaborates on strategies that pharmacists can use to optimize patient outcomes and minimize treatment delays.

Pharmacy Times: What are the key points of this study of blinatumomab in acute lymphoblastic leukemia/acute lymphocytic leukemia (ALL)?

Jose Tinajero: In our retrospective study of these patients with acute lymphoblastic leukemia (ALL) treated with blinatumomab, we found that patients harboring TP53 mutations were associated with an increased risk of CD19-negative relapse. This highlights that leukemia biology may predict and characterize some of the patterns of blinatumomab cyto-failure.

Pharmacy Times: What are the implications of these findings for the future development of targeted therapies for B-cell ALL (B-ALL)?

Tinajero: When future developments of targeted therapies in B-ALL are being considered, there are certain features that may not necessarily impact the initial response that we see, as we saw in our study, but there may be other features that influence relapse; in particular, losing CD19 as an immune escape.

Pharmacy Times: How can pharmacists better manage patients with B-ALL who are undergoing blinatumomab therapy, particularly in monitoring adverse events and potential drug interactions?

Tinajero: When it comes to pharmacists contributing to the management of ALL patients who are undergoing blinatumomab therapy, we know that with bispecific T-cell engaging therapies, cytokine release syndrome and neurotoxicity are some of the adverse events of interest. A pharmacist could contribute significantly to the operations of these therapies, such as inpatient-outpatient ministration, pharmacy and therapeutics or PMT involvement, patient education, staff education, as well as training. I think lastly, pharmacists are in a good position to also contribute to retrospective research to help optimize care.

Pharmacy Times: How might pharmacists leverage the certain genetic factors that influence response to blinatumomab to optimize patient care and counseling?

Tinajero: I think leveraging genetic factors to evaluate response to blinatumomab is something of interest as we are beginning to describe some of these experiences. Some of the retrospective studies that are currently being published out there, as more information and studies come out, we might be able to determine how to better mitigate some of these toxicities, or even optimize response as well as characterize duration response.

Pharmacy Times: What strategies can pharmacists discuss with health care providers to optimize patient outcomes and minimize treatment delays?

Tinajero: Some of the key strategies that pharmacists can discuss with health care providers to help optimize patient outcomes as well as minimize treatment delays are to ensure appropriate and guideline or policy support with anti-infective prophylactic measures when they're necessary; working with providers to counsel patients and support staff on key toxicities when receiving blinatumomab; and ensuring the prompt recognition and treatment of these toxicities by developing guidelines supported therapies and pathways. I would say those are some of the key points that I have.

Pharmacy Times: Is there anything else that you would like to add?

Tinajero: I think the audience, whether it's a seasoned pharmacist or just someone learning about bispecific T-cell engager therapy, should know this is a growing field. We have seen expansion in multiple myeloma, diffuse large B-cell lymphoma, and even our first in small cell lung cancer with tarlatamab (Imdelltra; Amgen), meaning that there are opportunities for pharmacists to be involved in education, the development of algorithms or adverse event management protocols, as well as research.