{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:57:31Z","timestamp":1781672251678,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute lymphoblastic leukemia (ALL) is the most common malignant hematological disease in children. Patients with high-risk ALL have a poor prognosis, and allogeneic hematopoietic stem cell transplantation (HSCT) is one of the important treatment modalities. However, post-transplant relapse of the primary disease remains one of the leading causes of treatment failure, seriously affecting the long-term survival of patients. Donor lymphocyte infusion (DLI) has been shown to have some efficacy in preventing relapse in B-cell ALL after HSCT, while the use of blinatumomab for preventing post-transplant relapse in ALL remains under investigation. Moreover, the safety and efficacy of the combination regimen for this indication still need to be verified in larger patient cohorts. We herein report a single case of a child with high-risk ALL who received blinatumomab combined with prophylactic DLI to prevent relapse after HSCT, along with a brief review of the relevant literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 5-year-old boy was diagnosed as ALL, early pro-B, KMT2A::USP2 fusion gene positive. After induction treatment with the SCCLG-ALL-2016 protocol, the minimal residual disease (MRD) by flow cytometry(FCM) and the quantitative PCR of KMT2A::USP2 fusion gene and NGS IGH remained continuous positive. The child received one cycle of blinatumomab, and the MRD by FCM and RQ-PCR turned negative after the blinatumomab regimen. Another two weeks of blinatumomab was given as bridge and then haploidentical HSCT was performed. Because his MRD by NGS IGH was 0.0311% before HSCT, the child received 3 cycles of blinatumomab and two prophylactic DLIs to prevent post-transplant relapse. During the treatment with blinatumomab and DLI, the child developed grade 1 cytokine release syndrome (CRS), without other severe adverse reactions such as neurotoxicity, hypoxemia, and hypotension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this pediatric patient with high-risk KMT2A::USP2-positive ALL, sequential blinatumomab plus prophylactic DLI was well-tolerated and maintained sustained remission after HSCT. This case preliminary supports the combined regimen for post-transplant relapse prevention in high-risk patients. Given case report limitations, larger prospective trials are needed to verify its safety, efficacy and optimal dosing for widespread clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1825841","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:50:33Z","timestamp":1781671833000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Safety and efficacy of blinatumomab in combination with donor lymphocyte infusion for the prophylaxis of relapse following allogeneic hematopoietic stem cell transplantation in a pediatric patient with acute lymphoblastic leukemia"],"prefix":"10.3389","volume":"17","author":[{"given":"Yi-Tong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Na","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Bin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1007\/s11899-018-0470-x","article-title":"CAR-T cell therapy for acute lymphoblastic leukemia: transforming the treatment of relapsed and refractory disease","volume":"13","author":"Pehlivan","year":"2018","journal-title":"Curr Hematol Malig Rep"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.921894","article-title":"Immunotherapy for pediatric acute lymphoblastic leukemia: recent advances and future perspectives","volume":"13","author":"Lv","year":"2022","journal-title":"Front Immunol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019004043","article-title":"How I treat relapsed acute lymphoblastic leukemia in the pediatric population","volume":"136","author":"Hunger","year":"2020","journal-title":"Blood"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-025-02676-1","article-title":"Outcomes of hematopoietic stem cell transplantation in pediatric acute lymphoblastic leukemia: a multicenter Brazilian cohort study","volume":"60","author":"Morales","year":"2025","journal-title":"Bone Marrow Transplant"},{"key":"B5","doi-asserted-by":"publisher","first-page":"68","DOI":"10.3324\/haematol.2015.131680","article-title":"Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome","volume":"101","author":"Oskarsson","year":"2016","journal-title":"Haematologica"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2025.287456","article-title":"Impact of minimal residual disease on the outcome of hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia within the FORUM trial","volume":"111","author":"Balduzzi","year":"2026","journal-title":"Haematologica"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-12-615757","article-title":"IgH-V(D)J NGS-MRD measurement pre- and early post-allotransplant defines very low- and very high-risk ALL patients","volume":"125","author":"Pulsipher","year":"2015","journal-title":"Blood"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1182\/hematology.2023000424","article-title":"Preventing relapse after CD19 CAR T-cell therapy for pediatric ALL: the role of transplant and enhanced CAR T cells","volume":"2023","author":"Talleur","year":"2023","journal-title":"Hematol Am Soc Hematol Educ Program"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.11817\/j.issn.1672-7347.2024.240351","article-title":"Efficacy of WT1 gene-guided pre-emptive therapy for prevention of relapse in acute myeloid leukemia after transplantation and its optimal intervention threshold","volume":"49","author":"Fang","year":"2024","journal-title":"Zhong Nan Da Xue Xue Bao Yi Xue Ban"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2023.04.012","article-title":"Olverembatinib treatment in pediatric patients with relapsed Philadelphia-chromosome-positive acute lymphoblastic leukemia","volume":"23","author":"Li","year":"2023","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024014043","article-title":"Blinatumomab use in pediatric B-ALL: where are we now","volume":"9","author":"Hall","year":"2025","journal-title":"Blood Adv"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(23)00436-9","article-title":"Sequential CD19 and CD22 chimeric antigen receptor T-cell therapy for childhood refractory or relapsed B-cell acute lymphocytic leukaemia: a single-arm, phase 2 study","volume":"24","author":"Pan","year":"2023","journal-title":"Lancet Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-024-01092-w","article-title":"Efficacy of blinatumomab as maintenance therapy for B-lineage acute lymphoblastic leukemia\/lymphoma following allogeneic hematopoietic cell transplantation","volume":"14","author":"Huang","year":"2024","journal-title":"Blood Cancer J"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2024-207450","article-title":"Blinatumomab added to chemotherapy improves disease-free survival in newly diagnosed NCI standard risk pediatric B-acute lymphoblastic leukemia: results from the randomized Children's Oncology Group Study AALL1731","volume":"144","author":"Rau","year":"2024","journal-title":"Blood"},{"key":"B15","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1182\/blood-2024-199937","article-title":"Efficacy and safety of adding blinatumomab to first-line treatment for Chinese children with B-cell acute lymphoblastic leukemia","volume":"144","author":"Qi","year":"2024","journal-title":"Blood"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1182\/blood-2024-210268","article-title":"Mini-dosed blinatumomab maintenance therapy following allogeneic hematopoietic stem cell transplantation in acute B-cell lymphoblastic leukemia","volume":"144","author":"Ji","year":"2024","journal-title":"Blood"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021013290","article-title":"Blinatumomab maintenance after allogeneic hematopoietic cell transplantation for B-lineage acute lymphoblastic leukemia","volume":"139","author":"Gaballa","year":"2022","journal-title":"Blood"},{"key":"B18","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1097\/jcma.0000000000000992","article-title":"Donor lymphocyte infusion for prophylaxis and treatment of relapse in pediatric hematologic Malignancies after allogeneic hematopoietic stem cell transplant","volume":"86","author":"Hou","year":"2023","journal-title":"J Chin Med Assoc"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2018.04.018","article-title":"Donor lymphocyte infusion in myeloid disorders","volume":"57","author":"Toprak","year":"2018","journal-title":"Transfus Apher Sci"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2016.67.3301","article-title":"Phase I\/Phase II study of blinatumomab in pediatric patients with relapsed\/refractory acute lymphoblastic leukemia","volume":"34","author":"von Stackelberg","year":"2016","journal-title":"J Clin Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021005579","article-title":"Blinatumomab in pediatric relapsed\/refractory B-cell acute lymphoblastic leukemia: RIALTO expanded access study final analysis","volume":"6","author":"Locatelli","year":"2022","journal-title":"Blood Adv"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0987","article-title":"Effect of blinatumomab vs chemotherapy on event-free survival among children with high-risk first-relapse B-cell acute lymphoblastic leukemia: a randomized clinical trial","volume":"325","author":"Locatelli","year":"2021","journal-title":"Jama"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1200\/jco.22.02200","article-title":"Children's Oncology Group AALL1331: phase III trial of blinatumomab in children, adolescents, and young adults with low-risk B-cell ALL in first relapse","volume":"41","author":"Hogan","year":"2023","journal-title":"J Clin Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13569","article-title":"Blinatumomab in pediatric patients with relapsed\/refractory B-cell precursor acute lymphoblastic leukemia","volume":"106","author":"Queudeville","year":"2021","journal-title":"Eur J Haematol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1540158","article-title":"Post-stem cell transplant maintenance for pediatric acute leukemias: insights from a Brazilian institution with a Latin American perspective","volume":"15","author":"Breviglieri","year":"2025","journal-title":"Front Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.62263","article-title":"Blinatumomab maintenance therapy following bone marrow transplantation for early relapsed pediatric B-cell precursor acute lymphoblastic leukemia and analysis of lymphocyte subset changes","volume":"16","author":"Abematsu","year":"2024","journal-title":"Cureus"},{"key":"B27","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1038\/s41409-023-02137-7","article-title":"Prophylactic versus preemptive modified donor lymphocyte infusion for high-risk acute leukemia after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study","volume":"59","author":"Yang","year":"2024","journal-title":"Bone Marrow Transplant"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2016.104","article-title":"Concurrent blinatumomab and donor lymphocyte infusions for treatment of relapsed pre-B-cell ALL after allogeneic hematopoietic cell transplant","volume":"51","author":"Ueda","year":"2016","journal-title":"Bone Marrow Transplant"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2025016915","article-title":"Harmonized immune recovery monitoring after HCT: evidence and practical guidance from the Westhafen Intercontinental Group","volume":"9","author":"Hammoudi","year":"2025","journal-title":"Blood Adv"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.19104","article-title":"Blinatumomab differentially modulates peripheral blood and bone marrow immune cell repertoire: a Campus ALL study","volume":"203","author":"Ocadlikova","year":"2023","journal-title":"Br J Haematol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-11-785865","article-title":"Immune regulatory cell infusion for graft-versus-host disease prevention and therapy","volume":"131","author":"Blazar","year":"2018","journal-title":"Blood"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1825841\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:50:58Z","timestamp":1781671858000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1825841\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":31,"alternative-id":["10.3389\/fimmu.2026.1825841"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1825841","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"article-number":"1825841"}}