blinatumomab at a glance
Medicine class
Bispecific T-cell engager immunotherapy
Usual role
Treatment of specified CD19-positive B-cell precursor ALL settings in adults and children
Administration
Continuous intravenous infusion through a pump under a specialist haematology team
Driving
Do not drive, operate machinery or undertake hazardous activities during the infusion because neurological effects can occur
What is blinatumomab used for?
UK-licensed uses cover these CD19-positive B-cell precursor ALL settings:
Adults with relapsed or refractory disease; Philadelphia chromosome-positive disease requires failure of at least two tyrosine kinase inhibitors and no alternative treatment option.
Adults with Philadelphia chromosome-negative disease in first or second complete remission who have minimal residual disease of at least 0.1%.
Adults with Philadelphia chromosome-negative disease during consolidation.
Children aged 1 year or older with Philadelphia chromosome-negative refractory disease, specified later relapse, or relapse after an allogeneic stem-cell transplant.
Children aged 1 year or older with Philadelphia chromosome-negative disease in first relapse during consolidation.
How does blinatumomab work?
Blinatumomab binds to CD19 on B-lineage cells and CD3 on T cells, bringing them together and activating the T cell to kill the target B cell.
blinatumomab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 38.5 micrograms
How to take blinatumomab
Blinatumomab is prepared by trained staff and given continuously into a vein using an infusion pump. Treatment begins under specialist supervision; selected patients may continue outside hospital after clinical assessment and training. Do not alter pump settings, restart a stopped pump, flush the treatment line or use that line for another medicine unless instructed by the specialist team.
Keep the catheter area clean and follow the team's pump and line-care instructions.
Carry the supplied patient card and treatment team's contact details.
Contact the team immediately if the pump alarms, stops or the infusion bag empties unexpectedly.
blinatumomab side effects
Common or expected effects
- Fever, chills and infusion-related reactions
- Infections and reduced white blood cells
- Anaemia or reduced platelets
- Headache or tremor
- Nausea, vomiting, diarrhoea, constipation or abdominal pain
- Rash, swelling, cough, back pain or limb pain
- Low or high blood pressure and a fast heartbeat
- Raised liver enzymes or reduced immunoglobulins
Get urgent medical advice
- Serious infection, particularly with a low white-cell count
- Confusion, reduced alertness, speech or writing difficulty, poor coordination, marked tremor or seizures
- Cytokine release syndrome
- Severe infusion or allergic reaction
- Tumour lysis syndrome
- Pancreatitis
- Possible HLH/IEC-HS
blinatumomab in pregnancy
Human pregnancy data are unavailable. Blinatumomab should be avoided unless the specialist considers that its potential benefit outweighs fetal risk. Effective contraception is required during treatment and for at least 48 hours afterwards. Following exposure, the newborn may need assessment for B-cell depletion and postponement of live vaccines.
blinatumomab while breastfeeding
Breastfeeding is contraindicated during treatment and for at least 48 hours afterwards because a risk to the infant cannot be excluded. Discuss feeding plans with the specialist team.
blinatumomab interactions
Formal interaction studies are limited. The clinical team should review all prescribed, non-prescribed and complementary products.
Warfarin and other narrow-therapeutic-index CYP450 substrates
Early cytokine release may temporarily alter metabolism, so adverse effects or anticoagulation may require closer monitoring.
Cyclosporine and other narrow-therapeutic-index transporter substrates
Blood concentrations may change temporarily and should be monitored where appropriate.
Live-virus vaccines
Not recommended shortly before treatment, during treatment or until B-cell counts have recovered. Agree vaccination timing with the specialist team.
Common questions about blinatumomab
Answers are fully visible for fast scanning and source review.
What type of treatment is blinatumomab?
A bispecific immunotherapy that connects T cells to CD19-positive B cells.
Which leukaemia does it treat?
Specified settings of CD19-positive B-cell precursor acute lymphoblastic leukaemia.
Can it be given outside hospital?
Some clinically assessed patients may continue ambulatory infusion after treatment begins under hospital supervision and appropriate support is available.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.