Two birds, one BiTE: blinatumomab achieves concurrent B-ALL control and EBV clearance in post-HSCT patients: two cases report

Hematopoietic stem cell transplantation (HSCT) is an effective treatment for refractory or relapsed acute lymphoblastic leukemia (ALL). However, persistent challenges, such as post-transplant relapse and Epstein-Barr virus (EBV) reactivation, remain unresolved. The current standard prophylactic strategies are complex to implement and demonstrate inconsistent efficacy. Optimizing methods to prevent cancer recurrence and control viremia is crucial for enhancing patient outcomes. We present two novel cases of patients with B-cell ALL who developed EBV viremia following allogeneic HSCT and received blinatumomab as a relapse prophylaxis. Both cases achieved sustained EBV eradication (for more than 3 months) following a course of blinatumomab (8 µg/day × 8 days), initiated during asymptomatic viremia at 3 months post-transplant. Both patients demonstrated favorable therapeutic outcomes. Blinatumomab may represent a promising therapeutic option for managing EBV viremia and providing relapse prophylaxis in patients with B-cell ALL following allogeneic HSCT.