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We analyzed 172 adults treated in first salvage with blinatumomab and\/or inotuzumab ozogamicin (InO)\u2013based regimens to determine prognostic factors and benefit from allo-HSCT after achieving remission. Relapse within 12 months of initial diagnosis (HR 2.21, 95%CI 1.28\u20134.16) and measurable residual disease (MRD) positivity by multiparametric flow cytometry after cycle 1 of salvage (HR 3.06, 95%CI 1.75\u20135.33) predicted inferior relapse-free survival (RFS) on multivariate analysis; both factors as well as older age predicted inferior overall survival (OS). Patients who achieved early flow MRD negativity and had late relapse or were primary refractory to frontline therapy did not benefit from allo-HSCT (4-year RFS 60% vs 63% without allo-HSCT,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.82), while allo-HSCT improved outcomes in patients with MRD positivity and\/or relapse within 12 months (4-year RFS 56% vs. 22% without allo-HSCT,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03). MRD status after cycle 1 of salvage therapy and duration of first remission can risk stratify adults with R\/R B-ALL; those with early MRD negativity and late relapse or primary refractory disease may have favorable outcomes without consolidative allo-HSCT.\n                  <\/jats:p>","DOI":"10.1038\/s41375-026-03056-4","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T07:14:56Z","timestamp":1784186096000},"page":"2008-2017","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of survival in adults with B-cell acute lymphoblastic leukemia treated with blinatumomab and\/or inotuzumab ozogamicin in first salvage"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2997-6071","authenticated-orcid":false,"given":"Roberta S.","family":"Azevedo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4465-6119","authenticated-orcid":false,"given":"Elias","family":"Jabbour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9702-8485","authenticated-orcid":false,"given":"Fadi G.","family":"Haddad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8607-9404","authenticated-orcid":false,"given":"Partow","family":"Kebriaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2473-911X","authenticated-orcid":false,"given":"Issa","family":"Khouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth J.","family":"Shpall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4314-5037","authenticated-orcid":false,"given":"Richard","family":"Champlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6026-4073","authenticated-orcid":false,"given":"Omer","family":"Karrar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9536-063X","authenticated-orcid":false,"given":"Manuel","family":"Maroun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6831-2567","authenticated-orcid":false,"given":"Jayastu","family":"Senapati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eitan","family":"Kugler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca S.","family":"Garris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7621-377X","authenticated-orcid":false,"given":"Farhad","family":"Ravandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1908-3307","authenticated-orcid":false,"given":"Hagop","family":"Kantarjian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2983-2738","authenticated-orcid":false,"given":"Nicholas J.","family":"Short","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"3056_CR1","doi-asserted-by":"publisher","first-page":"589","DOI":"10.3324\/haematol.2009.014274","volume":"95","author":"A Oriol","year":"2010","unstructured":"Oriol A, Vives S, Hernandez-Rivas JM, Tormo M, Heras I, Rivas C, et al. 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NJ has served on advisory boards and received honoraria from Pharmacyclics, Janssen, AbbVie, Genentech, AstraZeneca, BeOne, Eli Lilly, Nurix, BMS, SERB Pharma, Adaptive Biotechnologies, Kite\/Gilead, Cellectis, Autolus; has received research funding from Pharmacyclics, AbbVie, Genentech, AstraZeneca, BeOne, Eli Lilly, BMS, ADC Therapeutics, Cellectis, Adaptive Biotechnologies, Kite\/Gilead, Takeda, Newave, Carna Biosciences, Bioheng Therapeutics, Ubix Therapeutics, Ascentage. PK has received honoraria from Amgen, Pfizer Inc., and Kite. EJS has received consulting fees from NY Blood Center and Celaid Therapeutics; has served on an advisory board for Adaptimmune, Navan, Zelluna Immunotherapy, FibroBiologics, Axio, and Orca Biosystems. HK has received research funding from AbbVie, Amgen, Ascentage, BMS, Daiichi-Sankyo, Immunogen, Novartis; has received honoraria and consulting fees, and has served on advisory board for AbbVie, Amgen, Ascentage, Ipsen Biopharmaceuticals, KAHR Medical, Novartis, Pfizer, Shenzhen Target Rx, Stemline, Takeda. NJS has received consulting fees from Amgen, Pfizer Inc., GSK, Adaptive Biotechnologies, Autolus, Sanofi, Syndax, Merck, Ascentage, Novartis, AB Science; has received research funding from Takeda Oncology, Astellas Pharma Inc., Xencor, GSK, NextCure, Ascentage, Novartis, Hemogenyx, Vironexis, and Remedy Plan; and has received honoraria from Adaptive Biotechnologies, Novartis, Amgen, Takeda Oncology, Pfizer Inc., Astellas Pharma Inc., Sanofi, Merck, AstraZeneca. The remaining authors declare no competing financial interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"All methods were performed in accordance with the relevant institutional guidelines and regulations. Approval was obtained from the MDACC Institutional Review Board (PA18-0025). Informed consent was obtained from all study participants. No identifiable images are included in this study.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Ethics"}}]}}