Tyrosine kinase inhibitors with blinatumomab versus chemotherapy in Philadelphia-positive acute B-lymphoblastic leukemia

Tyrosine kinase inhibitors (TKIs) and blinatumomab have improved outcomes in Philadelphia-positive B-lymphoblastic leukemia (Ph + B-ALL). However, the efficacy of TKI and blinatumomab as a standalone regimen compared to the standard chemotherapy-plus-TKI approach remains uncertain. We conducted a single-center retrospective analysis of 47 patients, including 18 treated with TKI and blinatumomab (de novo: N = 13; relapsed: N = 5) and 29 treated with chemotherapy and TKI. Patients in the blinatumomab cohort were significantly older (median age 65 years vs. 48 years), had higher rates of active central nervous system disease (27.7% vs. 0%) and were less frequently consolidated with allogeneic stem cell transplantation (33% vs. 79%, p < .05). Despite these differences, overall survival (2-year OS: 87% vs. 78%), progression-free survival (PFS: 81% vs. 54%), and non-relapse mortality (NRM: 6.3% vs. 14%) were comparable. Severe treatment-related adverse events were significantly less frequent in the TKI and blinatumomab cohort, with no difference in early molecular complete response rates. Our findings, consistent with published prospective trials, highlight the safety and efficacy of TKI and blinatumomab in managing Ph + B-ALL.