Our viewpoint JUST OUT in @NatRevClinOncol on the role (or lack thereof) of blinatumomab for B-ALL in complete remission #leusm nature.com/articles/s4157… 
We present 4 points to think about when considering the use of blinatumomab for B-ALL in CR. I have a feeling Vinay Prasad (@PlenarySessShow), may have a few things to say about it. nature.com/articles/s4157…
1/ the methods of MRD testing are not universally agreed upon and have variable sensitivities. What is sometimes considered "negative" by one method may not be "negative" by another. bloodjournal.org/content/125/26…
2/ the trial that led to this accelerated approval of blinatumomab uses an analysis of survival by tumor response to conclude that MRD is a valid surrogate endpoint for OS. This method should NOT be used to imply causality. More in this thread:
3/ MRD has been shown to have prognostic implications, but the effect of treatment on eliminating MRD has not been shown to predict effects on the true end point (survival). More here: nature.com/articles/s4157…
4/ toxicity, including death, in a patient population who are otherwise considered to be in CR with conventional methods. These patients might not have disease relapse and are getting exposed to toxic therapy without knowing whether the outcome of interest will be altered.
A randomized ECOG trial is underway to evaluate the addition of blinatumomab to combination chemotherapy in patients with newly-diagnosed B-ALL. Preliminary results are expected in 2023.
Leukemia docs and transplanters out there, do you use blinatumomab in B-ALL in CR with detectable MRD?
