Immunotherapy for B-ALL (blinatumomab & inotuzumab)

What it is

These drugs target proteins on the surface of B-ALL cells. Blinatumomab (Blincyto) is a “BiTE” antibody that links a patient’s own T-cells to CD19 on the leukemia cells so the T-cells destroy them. Inotuzumab ozogamicin (Besponsa) is an antibody–drug conjugate that targets CD22 and carries a toxin inside the leukemia cell. Both are used for relapsed or refractory disease and for minimal residual disease (MRD) that persists after chemotherapy — and blinatumomab is now moving into frontline regimens.

Why it's done

• Relapsed or refractory B-ALL
• MRD-positive disease after chemotherapy
• As a bridge to a stem-cell transplant or CAR-T therapy
• Increasingly added to frontline treatment

How it’s given

Blinatumomab is given as a continuous IV infusion over weeks, often through a portable pump, usually starting in hospital. Inotuzumab is given as IV infusions in cycles. Both are managed by a hematology-oncology team with close monitoring.

What to expect

Used to achieve or deepen remission — often before a transplant or CAR-T. Response is followed with bone-marrow and MRD testing.

Risks & side effects

• Blinatumomab — cytokine release syndrome and neurologic effects (confusion, seizures)
• Inotuzumab — liver injury, including veno-occlusive disease (especially around transplant)
• Infusion reactions and low blood counts
• Infection risk

Alternatives