J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://jh.elmerpub.com

Original Article

Volume 14, Number 6, December 2025, pages 307-313

Outcomes of Hematopoietic Stem Cell Transplantation Following the Use of Blinatumomab in Pediatric Relapsed B-Cell Acute Lymphoblastic Leukemia: A Single-Center Experience

**Table 1.** Baseline Characteristics and Disease Profile of Pediatric Patients With Relapsed B-Cell Acute Lymphoblastic Leukemia Treated With Blinatumomab Prior to HSCT
Sl. No	Age/sex	Relapse type	MRD prior to HSCT	Type of donor	Conditioning	GVHD prophylaxis	Engraftment (days)	Chimerism at last follow-up	Post-HSCT complications	Status	Days since HSCT
CMV: cytomegalovirus; CNS: central nervous system; CR: complete remission; CSA: cyclosporine A; ES: engraftment syndrome; FluTBI: fludarabine-TBI; HSCT: hematopoietic stem cell transplantation; MMF: mycophenolate mofetil; MRD: measurable residual disease; PTCy: post-transplant cyclophosphamide; SR GVHD: steroid-refractory graft-versus-host disease; TBI: total body irradiation; TT-Flu-Bu: thiotepa-fludarabine-busulfan.
1	12/M	Second relapse late combined	Negative	Matched sibling	TT-Flu-Bu	CSA-Mtx	N +11 P +9	100%	Nil	CR 3	+1,015
2	5/M	Early isolated medullary relapse	Negative	Haploidentical	FluTBI	PTCy CSA MMF	N +12 P +15	100%	ES, CMV reactivation, SR GVHD	CR 2	+899
3	10/M	Late isolated medullary relapse	Negative	Haploidentical	FluTBI	PTCy CSA MMF	N +12 P +7	98.4%	ES, CMV reactivation, SR GVHD	CR 2	+177
4	5/M	Early combined relapse	Negative	Haploidentical	FluTBI	PTCy CSA MMF	N +12 P +9	100%	ES	CR 2	+59
5	5/M	Very early combined relapse (CNS)	Negative	Haploidentical	FluTBI cranial boost	PTCy CSA MMF	N +12 P +9	100%	ES, CMV reactivation	CR2	+52

Table 1. Baseline Characteristics and Disease Profile of Pediatric Patients With Relapsed B-Cell Acute Lymphoblastic Leukemia Treated With Blinatumomab Prior to HSCT

Sl. No

Age/sex

Relapse type

MRD prior to HSCT

Type of donor

Conditioning

GVHD prophylaxis

Engraftment (days)

Chimerism at last follow-up

Post-HSCT complications

Status

Days since HSCT

CMV: cytomegalovirus; CNS: central nervous system; CR: complete remission; CSA: cyclosporine A; ES: engraftment syndrome; FluTBI: fludarabine-TBI; HSCT: hematopoietic stem cell transplantation; MMF: mycophenolate mofetil; MRD: measurable residual disease; PTCy: post-transplant cyclophosphamide; SR GVHD: steroid-refractory graft-versus-host disease; TBI: total body irradiation; TT-Flu-Bu: thiotepa-fludarabine-busulfan.

12/M

Second relapse late combined

Negative

Matched sibling

TT-Flu-Bu

CSA-Mtx

N +11
P +9

100%

Nil

CR 3

+1,015

5/M

Early isolated medullary relapse

Negative

Haploidentical

FluTBI

PTCy CSA MMF

N +12
P +15

100%

ES, CMV reactivation, SR GVHD

CR 2

+899

10/M

Late isolated medullary relapse

Negative

Haploidentical

FluTBI

PTCy CSA MMF

N +12
P +7

98.4%

ES, CMV reactivation, SR GVHD

CR 2

+177

5/M

Early combined relapse

Negative

Haploidentical

FluTBI

PTCy CSA MMF

N +12
P +9

100%

CR 2

+59

5/M

Very early combined relapse (CNS)

Negative

Haploidentical

FluTBI cranial boost

PTCy CSA MMF

N +12
P +9

100%

ES, CMV reactivation

CR2

+52

**Table 2.** Summary of Trial and Real-World Outcomes of HSCT Following Blinatumomab in Pediatric Relapsed B-ALL Across Different Gross National Income Groups
Author/year/country income level	Design	Study population	Post-HSCT complications
B-ALL: B-cell acute lymphoblastic leukemia; CMV: cytomegalovirus; GVHD: graft-versus-host disease; HIC: high-income country; HSCT: hematopoietic stem cell transplantation; LMIC: low- and middle-income country; NRM: non-relapse mortality; R/R: relapsed/refractory.
von Stackelberg et al/2016/HIC [16]	Phase I/II clinical trial (pediatric R/R B-ALL)	Pediatric	Safety profile acceptable; no novel or excess transplant-specific toxicities attributable to prior blinatumomab.
Locatelli et al/2022/HIC [17]	Expanded access/pooled pediatric trial (RIALTO)	Pediatric	No consistent signal of increased post-HSCT complications.
Llaurador et al/2024/HIC [18]	Retrospective series	Pediatric	No increase in acute or chronic GVHD; normal engraftment kinetics.
Algeri et al/2025/HIC [15]	Retrospective series	Pediatric/young adult	Low NRM; GVHD incidence comparable.
Lu et al/2024/HIC [19]	Retrospective series	Mostly adults	No excess transplant toxicities; lower chronic GVHD.
Sayyed et al/2024/mixed [20]	Retrospective series	Mixed	No reproducible signal of increased post-HCT immune complications.
Chadha et al/2025/LMIC [6]	Retrospective series	Pediatric	No clear excess of GVHD, VOD, graft failure or infections attributable; limited data.
Tulsiyan et al (present)/2025/LMIC	Retrospective series	Pediatric	Limited data; engraftment syndrome and CMV reactivation more.

Table 2. Summary of Trial and Real-World Outcomes of HSCT Following Blinatumomab in Pediatric Relapsed B-ALL Across Different Gross National Income Groups

Author/year/country income level

Design

Study population

Post-HSCT complications

B-ALL: B-cell acute lymphoblastic leukemia; CMV: cytomegalovirus; GVHD: graft-versus-host disease; HIC: high-income country; HSCT: hematopoietic stem cell transplantation; LMIC: low- and middle-income country; NRM: non-relapse mortality; R/R: relapsed/refractory.

von Stackelberg et al/2016/HIC [16]

Phase I/II clinical trial (pediatric R/R B-ALL)

Pediatric

Safety profile acceptable; no novel or excess transplant-specific toxicities attributable to prior blinatumomab.

Locatelli et al/2022/HIC [17]

Expanded access/pooled pediatric trial (RIALTO)

Pediatric

No consistent signal of increased post-HSCT complications.

Llaurador et al/2024/HIC [18]

Retrospective series

Pediatric

No increase in acute or chronic GVHD; normal engraftment kinetics.

Algeri et al/2025/HIC [15]

Retrospective series

Pediatric/young adult

Low NRM; GVHD incidence comparable.

Lu et al/2024/HIC [19]

Retrospective series

Mostly adults

No excess transplant toxicities; lower chronic GVHD.

Sayyed et al/2024/mixed [20]

Retrospective series

Mixed

No reproducible signal of increased post-HCT immune complications.

Chadha et al/2025/LMIC [6]

Retrospective series

Pediatric

No clear excess of GVHD, VOD, graft failure or infections attributable; limited data.

Tulsiyan et al (present)/2025/LMIC

Retrospective series

Pediatric

Limited data; engraftment syndrome and CMV reactivation more.