In Reply We concur with Dr Shibusawa and colleagues that some authors have suggested that the presence of a high percentage of regulatory T cells in peripheral blood was associated with a lower probability of response to blinatumomab.1 However, we are not aware of any study indicating that a high percentage of regulatory T cells can affect the probability of response to chemotherapy. In our randomized clinical trial,2 blinatumomab was superior to chemotherapy for event-free survival in children with relapsed B-ALL. Therefore, the hypothesis raised by Shibusawa and colleagues does not explain the improved outcomes for patients randomized to immunotherapy.
Locatelli F, Zugmaier G, von Stackelberg A. Blinatumomab vs Chemotherapy Among Children With Relapsed Acute Lymphoblastic Leukemia—Reply. JAMA. 2021;326(4):359–360. doi:10.1001/jama.2021.8154
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