Blinatumomab

Blinatumomab is a monoclonal antibody targeted drug for the treatment of acute lymphoblastic leukaemia (ALL). Its monoclonal antibodies target the CD19 proteins on the surface of your leukaemia cells. This stimulates your immune system to destroy the leukaemia cells.

Blinatumomab is an antibody treatment that only targets the CD19 protein. It is called a monoclonal antibody because it only targets one protein.

Blinatumomab also binds to the CD3 protein on T-cells to help them recognise and attack the leukaemia cells.

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Blinatumomab can be used for some adults and children with B-cell ALL, although with certain restrictions.

It can treat both Philadelphia chromosome-positive and Philadelphia chromosome-negative ALL patients.

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Blinatumomab is continuously delivered via ‘smart’ infusion pumps over a period of four weeks. Infusion bags are changed two times per week. ‘Smart’ infusion pumps use computer technology and drug software libraries to reduce any dosing errors.

There is an induction phase and a consolidation phase with chemotherapy treatments.

You will be in hospital for the first nine days of the first cycle with blinatumomab and the first two days of the second cycle. Treatment is given to you as an outpatient after that. You often can have the treatment at home.

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No drug interaction studies of blinatumomab are available to date.

Your haematology team will ask you about other medications you are taking before you start. They will also inform you of things to avoid. It is prudent to tell your doctor or nurse that you are having blinatumomab if you need to start any other medications.

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Blinatumomab is a fairly new treatment but its effects may be seen over time as it is used more.

Fertility

No human studies have assessed the effects of blinatumomab on fertility. It may be hard to say what the effect is, as chemotherapy also damages fertility. Blinatumomab is also only used after these treatments. Discuss this with your doctor if you are concerned.

Pregnancy

Human reproductive studies with blinatumomab are not available. There is no data on the use of blinatumomab in pregnant women.

If there is a possibility of pregnancy, you should use effective contraception:

• During treatment with blinatumomab
• For at least 48 hours after treatment with blinatumomab

Breastfeeding

There is no evidence that blinatumomab or its metabolites can get into in human milk. But, given its pharmacological properties, breastfeeding still presents a possible risk to the newborn.

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This is not a full list of all the side effects that can happen. The patient information leaflet in your medicine package has more information. Or you can find the leaflet in the Electronic Medicines Compendium.

The most common side effects experienced by patients taking blinatumomab are given below. The percentages of patients affected by them are also included:

• Fever (70.8% of patients)
• Infusion-related reactions (33.4%)
• Headache (32.7%)
• Nausea (23.9%)
• Low levels of red blood cells - Anaemia (23.3%)
• Low levels of platelets – Bruising/bleeding (21.6%)
• Build-up of fluid in parts of the body causing swelling – Oedema (21.4%)

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The most serious side effects with blinatumomab are:

• Infections (26.6%)
• Neurological events (12.2%)
• Neutropenia/febrile neutropenia (9.1%)
• Cytokine release syndrome (2.7%)
• Tumour lysis syndrome (0.8%)

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If blinatumomab has not worked for you, other treatments are available. They include the targeted medicines inotuzumab ozogamicin and chimeric antigen receptor (CAR) T-cell therapy.

Other options include radiation therapy or stem cell transplant. Your consultant will be able to tell you about the best treatment for you going forward.

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