Hagop Kantarjian, Wei Qiao, Nitin Jain, Wei‐Ying Jen, Eitan Kugler, Nicholas J. Short, Rebecca Garris, Sherry Pierce, Partow Kebriaei, Sa A. Wang, Fadi Haddad, Farhad Ravandi, Xuelin Huang, Elias Jabbour
BACKGROUND AND STUDY AIMS: Historically, adults with B-cell acute lymphoblastic leukemia (ALL) treated with standard intensive chemotherapy in first salvage had a complete response rate of 40% and a 3-year survival rate <10%. The outcome of B-cell ALL on second-line therapy (salvage 1) is changing rapidly with the introduction of novel strategies into both frontline and salvage therapy. The study aim is to define the outcome of adult B-cell ALL on second-line therapy and its predictors in the novel era of ALL therapy. PATIENTS AND METHODS: A total of 372 adults with B-cell ALL in salvage 1 treated from 2000 until 2024 were analyzed. RESULTS: The complete remission (CR) rate was 70%; the 3-year survival rate was 30%. By multivariate analysis, the independent adverse predictors for CR were thrombocytopenia, unfavorable karyotype, and older era of therapy; combination of chemotherapy plus blinatumomab/inotuzumab was independently favorable. The independent adverse predictors of survival were older age, unfavorable karyotype, thrombocytopenia, and shorter duration of first CR; again, combination of chemotherapy plus blinatumomab/inotuzumab was independently favorable. Combination of chemotherapy and blinatumomab/inotuzumab was associated with a CR rate of 96% and a 3-year survival rate of 52%. CONCLUSIONS: This study establishes a modern expectation of outcome of adult B-cell ALL treated in salvage 1. Combination of chemotherapy and blinatumomab/inotuzumab should be a standard of care in adult B-cell ALL in salvage 1.