Objective Exploring the efficacy and safety of bridging blinatumomab(BiTE)in combination with chimeric antigen receptor T(CAR-T)cell therapy for the treatment of adult patients with acute B-cell lymphoblastic leukemia(B-ALL).Methods Clinical data from 36 adult B-ALL patients treated at the First Affiliated Hospital of Suzhou University from August 2018 to May 2023 were retrospectively analyzed.A total of 36 cases were included:18 men and 18 women.The median age was 43.5 years(21-72 years).Moreover,21 cases of Philadelphia chromosome-positive acute lymphoblastic leukemia were reported,and 16 of these cases were relapsed or refractory.Eighteen patients underwent blinatumomab bridging followed by CAR-T cell therapy,and 18 patients received CAR-T cell therapy.This study analyzed the efficacy and safety of treatment in two groups of patients.Results In the BiTE bridge-to-CAR-T group,16 patients achieved complete remission(CR)after BiTE immunotherapy,with a CR rate of 88.9％.One month after bridging CAR-T therapy,bone marrow examination showed a CR rate of 100.0％,and the minimal residual disease(MRD)negativity rate was higher than the nonbridging therapy group(94.4％vs.61.1％,Fisher,P=0.041).The incidence of cytokine release syndrome and other adverse reactions in the BiTE bridge-to-CAR-T group was lower than that in the nonbridging therapy group(11.1％vs.50.0％,Fisher,P=0.027).The follow-up reveals that 13 patients continued to maintain MRD negativity,and five patients experienced relapse 8.40 months(2.57-10.20 months)after treatment.Two of five patients with relapse achieved CR after receiving the second CAR-T cell therapy.In the nonbridging therapy group,10 patients maintained continuous MRD negativity,7 experienced relapse,and 6 died.The 1 year overall survival rate in the BiTE bridge-to-CAR-T group was higher than that in the nonbridging therapy group,with a statistically significant difference at the 0.1 level[(88.9±10.5)％vs.(66.7±10.9)％,P=0.091].Conclusion BiTE bridging CAR-T cell therapy demonstrates excellent efficacy in adult B-ALL treatment,with a low recent recurrence rate and ongoing assessment of long-term efficacy during follow-up.
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