Blinatumomab for Minimal Residual Disease Clearance in B-Acute Lymphoblastic Leukemia
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Abstract
Objective: To evaluate the efficacy, safety, and clinical impact of blinatumomab across the treatment continuum of B-cell acute lymphoblastic leukemia. Design: Systematic evidence synthesis of randomized clinical trials and comparative cohort studies. Subjects/Patients: Children, adolescents, and adults with newly diagnosed, relapsed or refractory, or minimal residual disease–positive B-cell acute lymphoblastic leukemia. Methods: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, PubMed Central, and ClinicalTrials.gov were searched from January 2010 through December 2025. Comparative randomized and observational studies evaluating blinatumomab versus chemotherapy were included. Data on survival, remission, minimal residual disease clearance, adverse events, and transplantation outcomes were qualitatively synthesized. Results: Blinatumomab significantly improved overall survival and complete remission rates compared with chemotherapy in relapsed or refractory disease. Minimal residual disease clearance occurred at higher frequencies and was consistently associated with improved long-term survival. Integration into consolidation and frontline therapy reduced relapse risk and enhanced transplantation eligibility. Treatment-related myelosuppression was lower than with chemotherapy, although immune-mediated adverse events were observed. Conclusion: Blinatumomab provides durable molecular remission, survival advantage, and improved tolerability, supporting its integration across multiple treatment phases of B-cell acute lymphoblastic leukemia.
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Copyright (c) 2026 Dr. Suhena Sarkar, MD, Birupaksha Biswas, MD
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