BRIEF RESEARCH REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicCommunity Series in Reducing Adverse Effects of Cancer Immunotherapy: Volume IIIView all 16 articles
The Timing of Concurrent Intrathecal Chemotherapy During Blinatumomab Infusion Influences Neurotoxicity in Pediatric Acute Lymphoblastic Leukemia
Provisionally accepted
- Shandong Provincial Hospital, Jinan, China
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Objective: To assess the safety profile of administering intrathecal (IT) chemotherapy concurrently with blinatumomab in pediatric patients with acute lymphoblastic leukemia (ALL). Methods: This retrospective analysis included 93 pediatric ALL patients treated between February 2021 and May 2025 who received blinatumomab. Results: Of the 93 enrolled patients (median [Q1, Q3] age, 6 [4, 12] years), 42 (45%) were given IT chemotherapy concurrently, while the remaining 51 (55%) served as controls. Neurotoxic events occurred in 8 patients (8.8%) overall, with no statistically significant difference between the concurrent IT and control groups (12% vs. 6%, p = 0.461). However, receiving IT chemotherapy on Day 1 of blinatumomab was strongly associated with neurotoxicity (OR = 15.6; 95% CI: 2.96–87.8; p = 0.001). Additional univariate predictors included CD4+ T cell count (OR = 0.03; 95% CI: 0.00–0.50; p = 0.045), serum albumin (OR = 1.17; 95% CI: 1.02–1.39; p = 0.042), and bone marrow blast percentage (OR = 1.05; 95% CI: 1.01–1.09; p = 0.017). Multivariate analysis identified Day 1 concurrent IT administration as an independent risk factor (OR = 12.5; 95% CI: 1.45–131; p = 0.023). Conclusions: Initiating IT chemotherapy on the same day as blinatumomab infusion significantly increases the risk of neurotoxicity in pediatric ALL patients.
Keywords: concurrent intrathecal (IT) chemotherapy, Blinatumomab, Neurotoxicity, pediatric, Acute Lymphoblastic Leukemia
Received: 22 Aug 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Liu, DAI, Guan, Liu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Bingju Liu
Guotao Guan
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