Health-related quality of life in adults with relapsed/refractory acute lymphoblastic leukemia treated with blinatumomab

Max S. Topp, Zachary Zimmerman, Paul Cannell, Hervé Dombret, Johan Maertens, Anthony Stein, Janet Franklin, Qui Tran, Ze Cong and Andre C. Schuh

Key points

  • Blinatumomab delays deterioration in health-related quality of life in adults with relapsed/refractory acute lymphoblastic leukemia.


In the phase 3 TOWER study, blinatumomab significantly improved overall survival in adults with relapsed or refractory (R/R) Philadelphia chromosome-negative (Ph–) B-cell precursor acute lymphoblastic leukemia (BCP-ALL) relative to standard-of-care chemotherapy. A secondary objective of this study was to assess the impact of blinatumomab on health-related quality of life (HRQL) as measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This analysis included the 342 of 405 randomized patients for whom baseline and ≥1 post-baseline result were available in any EORTC multi-item scale or single-item measure. In general, patients receiving blinatumomab (n=247) reported better posttreatment HRQL across all QLQ-C30 subscales, based on descriptive mean change from baseline, than did those receiving chemotherapy (n=95). The hazard ratios for time to a ≥10-point deterioration from baseline (TTD) in HRQL or death ranged from 0.42 to 0.81 in favor of blinatumomab, with the upper bounds of the 95% CI <1.0 across all measures, except insomnia, social functioning, and financial difficulties; sensitivity analysis of TTD in HRQL without the event of death were consistent with these findings. When treatment effect over time was tested using a restricted maximum likelihood-based mixed model for repeated measures analysis, p<0.05 was reached for blinatumomab vs chemotherapy for all subscale measures except financial difficulties. The clinically meaningful benefits in overall survival and HRQL support the clinical value of blinatumomab in patients with R/R Ph– BCP-ALL when compared with chemotherapy. Funded by Amgen (TOWER number, NCT02013167).

  • Submitted September 6, 2017.
  • Accepted April 26, 2018.