Blinatumomab

What is blinatumomab?

Blinatumomab is a medicine used to treat a type of blood cancer called acute lymphoblastic leukemia (ALL). Blinatumomab belongs to a group of drugs known as monoclonal antibodies. Blinatumomab targets specific features of leukemia cells and helps your immune system destroy them.

You may hear blinatumomab called by its brand name, Blincyto®. Blinatumomab comes as a clear solution that may appear slightly yellow.

Before giving blinatumomab to your child

Tell your child's health-care team if your child has an allergy to blinatumomab or any other ingredients in blinatumomab.

Talk with your child's health-care team if your child has a history of seizures. Precautions may need to be taken with this medicine if your child has a history of seizures.

How will your child receive blinatumomab?

Blinatumomab is given into your child's central venous catheter (intravenously, or by IV) with an IV infusion pump. The drug will be given continuously (24 hours a day) for 28 days through the IV, even when your child is sleeping. Your child will start the infusion as an inpatient so they can be closely monitored.

Once discharged, you will bring your child to the hospital every four days to have the IV bag containing the medicine replaced. You will be taught how to care for the IV bag containing the blinatumomab, how to run the IV infusion pump and who to contact if you have a problem with the IV infusion pump. Be sure to keep the information your child's health-care team provides in a handy place at home so you can refer to it easily.

What should you do if your child's IV infusion pump stops running or their IV line disconnects?

• Call your child's health-care team immediately if the blinatumomab is ever stopped or if your child's IV line disconnects.
• Record any time that the IV infusion pump is turned off or beeping.

What are the possible side effects of blinatumomab?

Your child may have some side effects while they take blinatumomab.

Call the hospital where your child is receiving treatment if your child has any new symptoms that worry you.

Most of the following side effects are not common, but they may be a sign of a serious problem. Call the hospital right away or take your child to the Emergency Department if your child has any of these side effects:

• fever and chills
• shortness of breath
• unusual tiredness or weakness
• muscle or joint pain
• rash
• diarrhea
• vomiting
• headache
• confusion
• seizures (body shaking or convulsions)
• dizziness, loss of balance, fainting
• trouble speaking

What safety measures should you take when your child is using this medicine?

Your child will be given medicine such as dexamethasone to prevent side effects of blinatumomab.

Your child should not drive a car, boat or motorcycle or operate machinery while getting blinatumomab as it may cause dizziness and confusion.

Blinatumomab can temporarily lower the number of white blood cells in the blood, increasing your child's chances of getting an infection. Your child can take the following precautions to prevent infections, especially when the blood count is low:

• Avoid people with infections, such as a cold or the flu.
• Avoid places that are crowded with large groups of people.
• Be careful when brushing or flossing your child's teeth. Your child's health-care provider or dentist may suggest different ways to clean your child's mouth and teeth.
• You or your child should not touch your child's eyes or inside their nose without washing your hands first.
• Your child's health-care provider will review with you what to do when you/your child has a fever.

Blinatumomab can lower the number of platelets in the blood, which can increase your child's risk of bleeding. You can take the following precautions:

• Be careful not to cut your child when using a razor, fingernail scissors or toenail clippers.
• Your child should avoid contact supports where bruising or injury could occur.
• Your child should not receive a permanent tattoo or any kind of body piercing.

There are some medicines that should not be taken together with blinatumomab, or, in some cases, the dose of blinatumomab or the other medicine may need to be adjusted. It is important that you tell your health-care provider and pharmacist if your child takes or plans to take any other medications (prescription, vitamins, over the counter or herbal supplements), including:

• acetylsalicylic acid or ASA (also known as Aspirin)
• ibuprofen (also known as Advil or Motrin) or naproxen (also known as Aleve)
• immunosuppressant medications, such as tacrolimus and cyclosporine
• blood-thinning medications, such as warfarin (Coumadin)

Your child should not receive any immunizations (vaccines) without their health-care provider's approval. Your child or anyone else in your household should not get the oral polio vaccine while your child is being treated for cancer. Tell your child's health-care provider if you or anyone in your household has recently received oral polio vaccine. Your child should avoid contact with anyone who has recently received this vaccine.

Blinatumomab may cause harm to the fetus if given during pregnancy. If your child is sexually active, they should use a form of birth control while receiving blinatumomab. Discuss options for birth control that will be safe and effective for your child while they are receiving blinatumomab. Tell your health-care provider right away if your child may be pregnant.

What other important information should you know?

• Keep the IV infusion of blinatumomab in the carrying bag at room temperature.
• Your child may shower or take a bath when getting blinatumomab. Use the dressing provided to keep the central line site dry.
• Keep a list of all medications your child is on and show the list to the health-care provider or pharmacist.
• Do not share your child's medicine with others and do not give anyone else's medicine to your child.

At SickKids

You will receive a Blinatumomab Caregiver Education Sheet. Keep this sheet in a handy place at home so you can refer to it easily.

Call the numbers listed on the Blinatumomab Caregiver Education Sheet if the blinatumomab is ever stopped, your child's IV line disconnects, or your child has any new symptoms that worry you.

Keep medications out of your child’s sight and reach and locked up in a safe place. If your child takes too much of a medication, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.