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This regimen is a **combination therapy** for relapsed/refractory B-cell acute lymphoblastic leukemia (ALL), particularly Philadelphia chromosome negative ALL in both adult and pediatric settings. It consists of the bispecific T-cell engager **blinatumomab** and a **low-intensity chemotherapy backbone (`mini-hyper-CVD` or `mini-hCVD`)**. The mini-hyper-CVD regimen involves lower-dose, anthracycline-free cycles of cyclophosphamide, vincristine, dexamethasone alternating with methotrexate and cytarabine. In some protocols, additional agents such as filgrastim/pegfilgrastim, methotrexate (IV and intrathecal), cytarabine (IV and intrathecal), leucovorin, mercaptopurine, prednisone, and rituximab are included. **Blinatumomab** is a bispecific T-cell engager antibody directed against CD19 and CD3, facilitating T-cell mediated destruction of malignant B cells. The regimen is designed to provide effective anti-leukemia activity with less toxicity than traditional chemotherapy. The protocol may be considered for patients with prior exposure to T-cell or B-cell directed therapies, in whom further intensive chemotherapy is contraindicated. This regimen is currently being studied at centers such as MD Anderson Cancer Center, and is under prospective clinical investigation for both safety and efficacy[1][2][3].
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