Outcomes of Hematopoietic Stem Cell Transplantation Following the Use of Blinatumomab in Pediatric Relapsed B-Cell Acute Lymphoblastic Leukemia: A Single-Center Experience
Bibliographic record
Abstract
Background: Relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL) remains associated with poor outcomes in children. Achieving measurable residual disease (MRD) negativity prior to allogeneic hematopoietic stem cell transplantation (HSCT) is critical for durable remission. Blinatumomab, a bispecific CD19-CD3 T-cell engager, induces deep remissions with minimal myelosuppression and is increasingly utilized as a bridge to HSCT. We describe our institutional experience with HSCT following blinatumomab-induced remission in pediatric R/R B-ALL. Methods: This retrospective single-center study included five pediatric patients with R/R B-ALL who received blinatumomab bridging therapy prior to allogeneic HSCT between January 2020 and June 2025. Clinical data included demographics, prior therapies, blinatumomab dosing and duration, MRD status, conditioning regimen, donor source, stem cell dose, engraftment kinetics, donor chimerism, and complications. The endpoints included MRD clearance before HSCT, engraftment kinetics, donor chimerism, viral reactivation, bacterial infections post-transplant, and overall and failure-free survival at last follow-up. Results: All five patients completed one to two 28-day cycles of blinatumomab and achieved MRD negativity (< 0.01%) prior to HSCT. Donor sources comprised one matched sibling and four haploidentical family donors. The median interval between blinatumomab completion and HSCT was 32 days. Median neutrophil and platelet engraftment occurred on days +12 and +9, respectively. Full donor chimerism was achieved within 1 - 3 months and sustained throughout follow-up. Post-transplant complications included engraftment syndrome (n = 4), cytomegalovirus (CMV) reactivation (n = 4), Epstein-Barr virus (EBV) reactivation (n = 1), Clostridioides difficile enterocolitis (n = 1), and steroid-refractory acute graft-versus-host disease (GVHD) (n = 2). No transplant-related mortality was observed. At a median follow-up of 173 days (range, 52 - 1,015 days), all patients remained alive and in continuous complete remission with no active GVHD. Conclusions: In this single-center experience from a low-/middle-income country (LMIC), blinatumomab served as an effective bridge to HSCT, enabling MRD-negative remissions with favorable post-transplant outcomes. Viral reactivations and steroid-refractory GVHD were reported, underlining the need for robust surveillance. Broader access to blinatumomab and prospective studies are needed to validate these findings and to evaluate cost-effectiveness in LMICs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".