How it is administered

Blinatumomab is given as a continuous intravenous (IV) infusion. It is supplied as a powder that is reconstituted and diluted before administration. The medication is infused over a period of 28 days, followed by a treatment-free interval. The exact dosing and schedule depend on the patient’s weight and the specific indication, and it is usually administered in a hospital setting for the first days of each cycle to monitor for side effects.

For pediatric and adult patients, the dose may be adjusted based on body surface area (BSA) if under 45 kg. The infusion can be administered over 24, 48, 72, 96 hours, or 7 days, depending on the preparation and patient needs. Special care is taken for neonates and infants regarding the solution used, as some preparations contain benzyl alcohol.

How it works

Blinatumomab is a bispecific T-cell engager (BiTE) antibody that targets two proteins: CD19, found on B-cell lymphocytes (including those in certain blood cancers), and CD3, found on T-cells. By binding to both CD19 and CD3, blinatumomab brings T-cells into close proximity with B-cells, including malignant (cancerous) B-cells. This connection activates the T-cells, prompting them to attack and destroy the CD19-positive B-cells.

The medication leads to the formation of an immune synapse between the T-cell and the cancer cell, resulting in T-cell activation, proliferation, and the release of cytotoxic proteins and inflammatory cytokines. This immune response helps eliminate cancerous B-cells from the body. Blinatumomab is especially useful in treating blood cancers like acute lymphoblastic leukemia (ALL) and is being studied and used in other CD19-positive blood cancers, including lymphoblastic lymphoma.

Who Should take it

Blinatumomab is indicated for adult and pediatric patients (one month and older) with:

• CD19-positive B-cell precursor acute lymphoblastic leukemia (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.

While blinatumomab is not specifically approved for lymphoblastic lymphoma, it may be considered in certain cases where the disease expresses CD19, as it works by targeting this marker. Your healthcare team will determine if blinatumomab is appropriate based on your specific diagnosis and disease characteristics.

Who should not take it

Blinatumomab should not be taken by patients with known hypersensitivity to blinatumomab or any of its components.

It should be used with caution in pregnant women, as it may cause harm to the fetus. Women of childbearing potential should use effective contraception during treatment and for 48 hours after the last dose. Blinatumomab is also not recommended for neonates or infants weighing less than 5.4 kg if the preparation contains benzyl alcohol, due to the risk of serious adverse reactions. Patients with active central nervous system (CNS) involvement or a history of significant neurologic events may require special consideration, as the medication can cause neurologic side effects.

Commonly used with

Blinatumomab is often used as part of a multi-phase chemotherapy regimen for blood cancers. It is commonly administered after or in combination with other chemotherapy agents, such as dexamethasone (as premedication to reduce the risk of infusion reactions), and sometimes with other supportive medications to prevent infections or manage side effects.

Patients may also receive intrathecal chemotherapy (chemotherapy delivered into the spinal fluid) to prevent or treat central nervous system involvement.

Commonly tested with

Blinatumomab has been tested in combination with various chemotherapy regimens, including intensive chemotherapy protocols for acute lymphoblastic leukemia. It is also studied in combination with corticosteroids (like dexamethasone or prednisone) to reduce the risk of infusion reactions and manage side effects.

Clinical trials have evaluated its use as consolidation therapy, in relapsed or refractory disease, and in patients with minimal residual disease. It is also tested with supportive care agents to prevent infections and other complications.