blinatumomab: clinical use

Prescribing considerations

• Initiate and supervise treatment through clinicians experienced in haematological malignancy.
• Provide patient or caregiver educational material and a patient card.
• Assess neurological history, active infection, tumour burden, previous infusion reactions and central nervous system involvement.
• Use strict aseptic preparation and administration procedures to minimise medication errors.
• Record the product name and batch number for biological traceability.

Contraindications and cautions

• Hypersensitivity to blinatumomab or an excipient.
• Breastfeeding during treatment and for the specified post-treatment period.
• Exercise particular caution with active uncontrolled infection, clinically relevant neurological disease, high tumour burden, severe renal impairment, previous cranial irradiation or neurotoxic therapy.

Monitoring

• Baseline and ongoing neurological assessment, including communication and writing where clinically useful.
• Clinical surveillance for cytokine release syndrome, infection, infusion reactions, HLH/IEC-HS and pancreatitis.
• Full blood count, neutrophils, liver tests, renal function, electrolytes, uric acid and fluid balance as clinically indicated.
• Consider immunoglobulin monitoring, particularly in older adults.
• At relapse, reassess CD19 expression and remain alert to lineage switch.

Clinical pharmacology

Blinatumomab is a recombinant bispecific T-cell engager linking CD3-positive T cells to CD19-positive B cells. This produces T-cell activation, cytokine release and cytolytic destruction of target cells. Its short elimination half-life necessitates continuous infusion.

Formulation and product differences

• The presentation contains a powder for concentrate and a separate stabiliser solution. Add the stabiliser to the infusion bag; do not use it to reconstitute the powder.
• Prepared solution requires a compatible pump, dedicated lumen and low-protein-binding in-line filter. The infusion line must not be flushed.

Solution for infusion

Route: Intravenous

Strengths: 38.5 micrograms