Classification: Bispecific T Cell Engager
About Blinatumomab (Blincyto®)
Blinatumomab is a type of medication called a "bispecific T-cell engager" (BiTE) antibody. This works by directing the body’s T cells (part of the immune system) to target and destroy cells that have the CD19 protein on their surface. CD19 is found on the surface of B-cell leukemias and lymphomas.
How to Take Blinatumomab
Blinatumomab is given by intravenous (IV, into a vein) infusion, 24 hours a day, for 28 consecutive days. The infusion is then stopped for 2 weeks and then restarted for the next 28-day cycle. Patients are given a steroid premedication prior to starting the infusion and prior to any dose increase. The infusion is started in the hospital and you will be monitored in the hospital for several days, the actual number of days depends on which cycle of the infusion you are receiving.
Because you will be receiving this medication for 4 weeks, you will have a home care nurse to manage the infusion at home. You should have contact information about who to call should your infusion pump alarm at any time of day. It is important that you not reset the pump yourself.
Special Instructions: While receiving this medication, you should NOT drive, operate heavy machinery or do any dangerous activities because of the risk of neurologic side effects.
Possible Side Effects
There are a number of things you can do to manage the side effects of blinatumomab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Cytokine Release Syndrome or Infusion Reactions
Cytokine release syndrome (CRS) can occur. T cells are activated by the medication prior to being destroyed, causing them to release many cytokines. The cytokines cause an inflammatory response in the body – similar to if the body had a severe infection. This reaction, if left untreated, can be very dangerous. Your care team will monitor you closely for CRS or an allergic reaction. During the infusion, if you experience difficulty breathing or swallowing, facial swelling, experience chest pain, "racing" heart, cough or wheezing, develop flushing, hives or rash, nausea or vomiting, lightheadedness, headache, fever, chills, or shakes, inform your nurse immediately. Additional medications may be given to alleviate your discomfort. Your infusion may be slowed, or temporarily or permanently stopped.
Patients can experience serious neurologic complications, which can occur at any time, even a week or more into the infusion. These included seizures, confusion, disorientation, difficulty speaking or slurred speech, loss of balance of loss of consciousness. Notify your care team right away if you develop any neurologic changes. These concerns are the reason you are told not to drive or operate heavy machinery.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
For more suggestions, read the Neutropenia Tip Sheet.
Nausea and/or Vomiting
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day and keep active. Your doctor or nurse can also recommend medications to relieve constipation. A stool softener and/or stimulant, such as senna, once or twice a day may prevent constipation. Notify your healthcare team if you do not have a bowel movement for 3 or more days.
Other Possible Side Effects
Side effects seen in clinical trials include: fever, headache, swelling, hypokalemia (low levels of potassium) and rash.
If your white blood cell (lymphocyte) count is very high prior to treatment, you may be at risk for tumor lysis syndrome. This happens when the cancer cells die too quickly and their waste products overwhelm the body. You may be given a medication (allopurinol) and IV fluids to help prevent this. If you experience nausea, vomiting, diarrhea, or become lethargic (drowsy, sluggish), notify your oncology team right away.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving this medication.