How it is administered

Blinatumomab is given as a continuous intravenous (IV) infusion. It is supplied as a lyophilized powder that is reconstituted and diluted before administration. The medication is delivered through an infusion pump, typically over 28 days for each treatment cycle, followed by a treatment-free interval. The infusion can be administered over 24, 48, 72, 96 hours, or up to 7 days, depending on the specific preparation and patient needs. Hospitalization is recommended for the first few days of the first and second cycles to monitor for side effects. The dose is based on patient weight and body surface area, especially for children and those under 45 kg.

How it works

Blinatumomab is a bispecific T-cell engager (BiTE) antibody that targets CD19 on B cells and CD3 on T cells. By binding to both these proteins, blinatumomab brings T cells (a type of immune cell) into close proximity with B cells, including cancerous B cells found in certain blood cancers like acute lymphoblastic leukemia (ALL). This connection activates the T cells, prompting them to attack and destroy the CD19-positive B cells.

The medication works by forming a bridge between the patient’s own immune system and the cancer cells, leading to the destruction of malignant B cells. This mechanism is particularly effective in B-cell precursor ALL, where the cancer cells express CD19. Blinatumomab also causes a temporary redistribution of T cells and a rapid reduction in B-cell counts, which is a sign that the immune system is targeting the cancer.

Who Should take it

Blinatumomab is indicated for adults and children (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) of 0.1% or higher.
• 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 standard treatments have not worked, or when there is a high risk of the disease returning. It may also be used as part of a consolidation regimen to help prevent relapse after initial chemotherapy has achieved remission.

Who should not take it

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

Pregnant women should avoid blinatumomab because it may cause harm to the fetus. Women of reproductive potential should use effective contraception during treatment and for at least 48 hours after the last dose. Patients with active central nervous system (CNS) leukemia or a history of significant neurological disorders should discuss risks with their doctor, as blinatumomab can cause serious neurological side effects.

Commonly used with

Blinatumomab is often used as part of a treatment regimen that may include other chemotherapy agents, especially during the consolidation phase of therapy for ALL. It is also commonly given with corticosteroids such as dexamethasone or prednisone to help prevent or manage infusion reactions and side effects like cytokine release syndrome.

In some protocols, blinatumomab is used after initial induction chemotherapy, or in combination with supportive treatments like antibiotics or growth factors to manage side effects.

Commonly tested with

Blinatumomab has been tested in combination with various chemotherapy regimens, particularly in the consolidation phase of ALL treatment. It is also studied alongside corticosteroids (such as dexamethasone) for premedication and side effect management. In clinical trials, it is often compared to or combined with standard-of-care chemotherapy drugs, and sometimes with tyrosine kinase inhibitors in Philadelphia chromosome-positive ALL.