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A proposed mechanism for the escape of malignant lymphoblasts and mode of blinatumomab. The figure illustrates how cytotoxic T cell (CTLs) and T helper (Th) of donors cooperate to kill lymphoblasts via the incompatible HLA molecules, that is alloreactivity. Under the immunological pressure of donor T cells, leukemic cells escape from immunosurveillance by loss of the genome of patient-specific HLA. Blinatumomab can redirect donor T cells to malignant lymphoblasts.
