What is blinatumomab?
Blinatumomab (also called Blincyto®) is a medicine called a monoclonal (mah neh CLOH nl) antibody. Monoclonal antibodies are proteins made in a lab that can find and attach to certain substances in the body, such as cancer cells. Once attached, they can recruit parts of your child’s immune system to destroy the cancer cells. This medicine is used to treat a certain type of cancer called acute lymphoblastic leukemia (ALL).
Blinatumomab can pose a health hazard to caregivers. All caregivers should take safety precautions while giving this drug. For 48 hours after this drug is given, the patient’s body fluids can contain the drug. During the infusion and for 48-hours after it ends, caregivers should follow safety guidelines when handling the patient’s vomit, blood ,urine, and bowel movements, including diapers. These guidelines include wearing gloves when cleaning up body fluids. For a complete list of safety precautions, see “Do you know… Protecting Caregivers from Drug Hazards.”
How is blinatumomab given?
This medicine is given into your child’s vein, called an IV infusion (in FEW zhen). It is usually given in 28-day cycles. The infusion will run continuously during the 28 days. Your child will need to be attached to the infusion device at all times.
If your child currently has a subcutaneous port—a port placed under the skin—the doctor may recommend inserting a central venous line before starting treatment. This is not required, but children with ports require many needle sticks in their arms for labs and other medicines while receiving blinatumomab.
How often will my child have to stay in the hospital while receiving blinatumomab?
During the first cycle of blinatumomab, your child will be admitted to the hospital the night before treatment begins. They will stay in the hospital for at least 3 days. Some patients may require a longer hospital stay, depending on the treatment plan. Your doctor will talk with you about how long your child might need to be in the hospital. While in the hospital, your child will be watched closely. You will receive training on how to care for your child and the device during the infusion. If your child tolerates, or does well with, the infusion, you will be able to leave the hospital with the infusion running.
Each time a cycle of blinatumomab is started, the staff will watch your child closely. Your child will be admitted to the hospital for the beginning of every treatment cycle.
How often will we come to the Medicine Room while receiving blinatumomab?
After leaving the hospital, you will return to the Medicine Room on a schedule to have the bag changed by a nurse. Your doctor and pharmacist will decide how often the infusion bag will be changed. For most children, bag changes occur at the same time every 48 hours. In some cases, the doctor and pharmacist may recommend bag changes on a different schedule, such as every day or every 7 days. After a schedule is made, it will not be changed unless there is a medical need to make a change.
Can we leave the Memphis area while my child is receiving blinatumomab?
The St. Jude staff recommends that children stay in the Memphis area during their blinatumomab cycles.
In some cases, the doctor may permit returning home, if the patient meets certain criteria. This requires a complex plan that involves other hospitals. The decision to receive care outside the Memphis area can only be made before starting a cycle of blinatumomab.
Are there serious side effects with blinatumomab?
During treatment cycles, the staff will watch your child closely for side effects using lab tests and exams. The following are the most serious possible side effects that the staff will be looking for:
Cytokine release syndrome
Cytokine release syndrome (CRS) is a serious, fast immune response that can be triggered when blinatumomab is started. Symptoms of CRS include fever, chills, low blood pressure, shortness of breath, low oxygen levels in the blood, and joint or muscle pain. It can lead to serious health problems and death. Before receiving blinatumomab, the staff will give your child a medicine to help prevent this reaction. Usually, this medicine is dexamethasone, a steroid. CRS is most likely to occur within a few days of starting treatment. Your child’s vital signs will be checked closely during the first few days of receiving blinatumomab.
Neurologic side effects
Neurologic (nur ah LOJ ik) side effects can happen at any time during treatment with blinatumomab. These side effects can range from headache, feeling confused, problems with balance or trouble speaking to seizures. Children may also feel agitated, irritable, or drowsy. Be sure the doctor knows if your child has had seizures or other neurologic problems before starting treatment. Throughout treatment cycles, your child will have regular tests for possible neurologic side effects. Tell the doctor right away if your child seems confused, passes out (unconscious), or has trouble speaking, loss of balance, or uncontrolled jerking motions.
What other side effects can blinatumomab cause?
The most common side effects of blinatumomab include:
- Flu-like symptoms (fever, chills)
- Swelling of arms or legs
- Nausea or vomiting
- Low blood counts (may increase risk of infection, bleeding, and fatigue)
- Fatigue or weakness
- Low blood pressure
Blinatumomab may cause these side effects that can be severe or life-threatening:
- Cytokine release syndrome (CRS)
- Neurologic side effects
- Abnormal liver blood tests
- Inflamed, swelling of the pancreas (pancreatitis)
What are the safety risks when handling the blinatumomab infusion line?
Blinatumomab infusions must be handled carefully. To avoid possible health problems, you will be trained to safely care for your child and the device during the blinatumomab infusion.
It is important to know that the blinatumomab line should never be flushed. Flushing the line can lead to serious health problems for your child, including CRS. Blinatumomab should not be infused in the same line as other medicines.
Blinatumomab infusions should only be handled by someone who is trained and knows its risks. To help assure this, the infusion line will be labeled to show that it is a high-risk medicine. Your doctor will provide a travel letter that says your child is receiving a medicine that should not be flushed. You should keep a copy of this letter with you at all times in case your child requires care at a hospital outside St. Jude.
What if the blinatumomab infusion is interrupted?
Blinatumomab infusions should not be stopped for long periods of time. Your nurses will try to avoid pauses in the infusion. Most of the regular care your child receives will be scheduled around blinatumomab bag changes to limit pauses in the infusion. Usually, nurses will not pause the infusion unless there is an emergency.
If the infusion is stopped for more than 4 hours in a row, the risk for CRS goes up. Tell your clinic or the Medicine Room staff right away if the infusion stops for more than 30 minutes or an unknown amount of time while you are away from the hospital. To avoid serious health problems, do not restart blinatumomab after it has been off for more than 4 hours. Restarting the infusion after 4 hours requires medicine to help prevent CRS and close watching by medical staff. If this happens, your child might need to be admitted to the hospital to re-start the infusion.
If you have questions about blinatumomab, please talk to your child’s doctor, nurse, or pharmacist. In the local area, call 901-595-3300. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833).
This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.
St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).
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