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**Blinatumomab + inotuzumab ozogamicin** is a sequential or concurrent immunotherapy combination used primarily for relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) and newly diagnosed B-ALL in older adults. Blinatumomab is a bispecific T-cell engager (BiTE) monoclonal antibody that binds CD3 on T cells and CD19 on B-ALL blasts, redirecting cytotoxic T cells to induce perforin-mediated lysis of cancer cells. Inotuzumab ozogamicin is a CD22-directed antibody-drug conjugate (ADC) comprising a humanized IgG4 anti-CD22 monoclonal antibody conjugated via an acid-labile linker to N-acetyl-gamma-calicheamicin dimethylhydrazide, a potent DNA-binding calicheamicin derivative that causes double-strand DNA breaks, cell cycle arrest, and apoptosis upon lysosomal release. Developed by Amgen (blinatumomab, branded Blincyto) and Pfizer (inotuzumab ozogamicin, branded Besponsa), this regimen achieves high complete remission rates (63-93% depending on sequence), frequent minimal residual disease negativity (up to 60%), and serves as a bridge to allogeneic hematopoietic stem cell transplantation, with demonstrated efficacy in real-world and clinical trial settings including dose-dense mini-Hyper-CVD backbones.[1][3][5][7]
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