How it is administered

Blinatumomab is given as a continuous intravenous (IV) infusion. The medication comes as a white to off-white powder that is mixed with a special solution and then further diluted for infusion. The infusion is administered through a pump, typically over 28 days for each treatment cycle, followed by a treatment-free interval. The dosing and duration may vary based on your weight and the specific phase of treatment (induction, consolidation, or maintenance). Hospitalization is recommended at the start of treatment for close monitoring. For pediatric patients and those weighing less than 45 kg, dosing is based on body surface area.

Blinatumomab is not given as a pill or injection under the skin; it must be infused directly into a vein.

How it works

Blinatumomab is a type of immunotherapy called a bispecific T-cell engager (BiTE). It works by connecting two types of cells in your body: T-cells (a type of immune cell) and B-cells (which can become cancerous in acute lymphoblastic leukemia, or ALL). Blinatumomab binds to a protein called CD19 on B-cells and another protein called CD3 on T-cells. By bringing these cells together, blinatumomab activates the T-cells to attack and destroy the cancerous B-cells.

This targeted approach helps your immune system recognize and kill leukemia cells that might otherwise escape detection. The medication can cause a rapid decrease in B-cell numbers and may lead to an initial increase in immune activity, which is why close monitoring is important, especially at the start of treatment.

Who Should take it

Blinatumomab is approved for adults and children (one month and older) with certain types of acute lymphoblastic leukemia (ALL), specifically:

• CD19-positive B-cell precursor ALL in first or second complete remission with minimal residual disease (MRD) ≥0.1%.
• Relapsed or refractory CD19-positive B-cell precursor ALL.
• CD19-positive Philadelphia chromosome-negative B-cell precursor ALL in the consolidation phase of multiphase chemotherapy.

It is used when the leukemia cells express the CD19 protein and may be recommended if the disease has returned after previous treatment, has not responded to other treatments, or if there is evidence of persistent disease after initial therapy.

Who should not take it

You should not take blinatumomab if you have had a known hypersensitivity (allergic reaction) to blinatumomab or any of its ingredients.

Special caution is needed for patients with a history of severe neurological disorders, active infections, or those who are pregnant or breastfeeding. The medication may cause harm to an unborn baby, so effective birth control is recommended during treatment and for at least 48 hours after the last dose. Blinatumomab should also not be used in neonates (newborns) with very low birth weight or early preterm birth due to the risk of benzyl alcohol toxicity from certain preparations.

Commonly used with

Blinatumomab is sometimes used in combination with other chemotherapy drugs as part of a multiphase treatment plan for ALL. It is also commonly used with corticosteroids (such as dexamethasone or prednisone) to help prevent or manage side effects like infusion reactions or cytokine release syndrome.

Intrathecal chemotherapy (chemotherapy injected into the spinal fluid) is often given before and during blinatumomab treatment to help prevent leukemia from spreading to the central nervous system.

Commonly tested with

Blinatumomab has been studied both as a single agent and in combination with standard chemotherapy regimens for ALL. It is often tested alongside corticosteroids (like dexamethasone) and sometimes with other supportive medications to manage side effects.

Clinical trials have compared blinatumomab to standard chemotherapy in both adults and children with relapsed or refractory ALL, as well as in the consolidation phase of treatment.