Blinatumomab Treatment: Uses, Dosage, and Side Effects

Summary of Key Points

Blinatumomab is a prescription medication used to treat specific types of leukemia, including acute lymphoblastic leukemia (ALL). It works by helping the immune system identify and destroy cancer cells. Administered through an intravenous (IV) infusion, Blinatumomab is typically prescribed for patients whose leukemia has returned (relapsed) or has not responded to previous treatments. Always consult your healthcare provider before starting or adjusting your dosage.

Names of the Medication

US Brand Name: Blincyto

Generic Name: Blinatumomab

The generic name, Blinatumomab, refers to the active ingredient in the medication, while the brand name, Blincyto, is the name given by the manufacturer.

Pharmacologic Category

1. Monoclonal Antibody
2. Anti-CD19 Immunotherapy
3. Bi-specific T-cell Engager (BiTE)

Blinatumomab Dosing Guidelines

Blinatumomab is used to treat various forms of acute lymphoblastic leukemia (ALL) in adults. The dosing schedule depends on the specific type of leukemia being treated. Below are the dosing guidelines for each condition. Always consult your healthcare provider before making any changes to your dosage. If you have questions or concerns, you can schedule a telemedicine visit with one of our providers for further guidance.

Dosing for Acute Lymphoblastic Leukemia (ALL)

Indication: For adults with relapsed or refractory B-cell precursor ALL.

Dosage: 9 mcg/day via continuous IV infusion on Days 1-7, followed by 28 mcg/day on Days 8-28 of a 42-day cycle.

Frequency: Repeat every 6 weeks.

Length of Treatment: Typically 2 cycles, with potential extensions based on the patient’s response to treatment.

Dosing for Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

Indication: For adults with Philadelphia chromosome-positive ALL.

Dosage: 9 mcg/day via continuous IV infusion on Days 1-7, followed by 28 mcg/day on Days 8-28 of a 42-day cycle.

Frequency: Repeat every 6 weeks.

Length of Treatment: Typically 2 cycles, with potential extensions based on the patient’s response to treatment.

Dosing for Minimal Residual Disease-Positive Acute Lymphoblastic Leukemia

Indication: For adults with minimal residual disease (MRD)-positive ALL.

Dosage: 28 mcg/day via continuous IV infusion for 28 days of a 42-day cycle.

Frequency: Repeat every 6 weeks.

Length of Treatment: Typically 1 cycle, with potential extensions based on the patient’s response to treatment.

For other types of ALL, including high-risk or pediatric cases, dosing may differ. Consult your healthcare provider to determine the most appropriate treatment plan for your specific condition. If you need immediate assistance, consider scheduling a telemedicine appointment with one of our providers.

Dosage Forms and Strengths

Solution for IV infusion: 35 mcg/vial

Blinatumomab Administration Guidelines

Blinatumomab is administered as a continuous intravenous (IV) infusion, delivering the medication directly into the bloodstream over a set period, typically 24 hours a day for several days. This treatment is usually provided in a hospital or clinic setting. In some cases, it may be administered at home under strict medical supervision. Always follow your healthcare provider’s instructions for administration, and contact them immediately if you experience any issues during treatment.

Blinatumomab Side Effects and Adverse Reactions

As with all medications, Blinatumomab may cause side effects. While some are common and manageable, others are rare but potentially serious. If you experience any side effects, contact your healthcare provider promptly. You can also schedule a telemedicine appointment with one of our providers to discuss your symptoms and receive guidance.

Common Side Effects (Affecting More Than 10% of Patients)

1. Fever: A temporary increase in body temperature.
2. Headache: Mild to moderate pain in the head or neck area.
3. Fatigue: Persistent tiredness or lack of energy.
4. Nausea: A sensation of discomfort or unease in the stomach.

Less Common Side Effects (Affecting 1-10% of Patients)

1. Chills: Episodes of shivering, often accompanied by a fever.
2. Dizziness: A feeling of lightheadedness or unsteadiness.
3. Low Blood Pressure: A drop in blood pressure that may cause fainting or dizziness.

Serious Side Effects (Rare but May Require Immediate Medical Attention)

1. Cytokine Release Syndrome (CRS): A severe immune response that can cause fever, low blood pressure, and difficulty breathing.
2. Neurological Side Effects: Symptoms such as confusion, seizures, or trouble speaking.
3. Infections: An increased risk of infections due to a weakened immune system.

Contraindications

A contraindication refers to a specific condition or circumstance in which a treatment or medication should not be used because it may cause harm to the patient. Blinatumomab, a monoclonal antibody therapy, has several contraindications that patients and healthcare providers must carefully evaluate before starting treatment.

Contraindications for Blinatumomab Treatment

Hypersensitivity to Blinatumomab or its components: Patients who have previously experienced an allergic reaction to Blinatumomab or any of its ingredients should avoid this medication. Allergic reactions can vary in severity, ranging from mild symptoms like skin rashes to severe, life-threatening reactions such as anaphylaxis.

Severe infections: Blinatumomab can suppress the immune system, making it more difficult for the body to fight infections. If a patient has an active, severe infection, using Blinatumomab could worsen their condition and delay recovery.

Uncontrolled central nervous system (CNS) disease: Blinatumomab is known to cause neurological side effects. For patients with pre-existing CNS conditions, such as epilepsy or brain metastases, these side effects may become more pronounced, potentially leading to complications like seizures, confusion, or other cognitive impairments.

Drug-to-Drug Interactions

Blinatumomab may interact with other medications, which can either amplify side effects or reduce the effectiveness of Blinatumomab or the other drugs involved. It is essential for patients to provide their healthcare provider with a complete list of all medications they are taking, including prescription drugs, over-the-counter medications, supplements, and herbal remedies.

Medications That May Interact with Blinatumomab

Corticosteroids (e.g., Prednisone, Dexamethasone): These medications suppress the immune system. When used alongside Blinatumomab, they may increase the risk of infections or exacerbate immune-related side effects.

Immunosuppressants (e.g., Tacrolimus, Cyclosporine): Commonly prescribed to prevent organ rejection or manage autoimmune conditions, these drugs can further weaken the immune system when combined with Blinatumomab, heightening the likelihood of infections.

Live vaccines: Vaccines containing live viruses, such as the measles, mumps, and rubella (MMR) vaccine or the chickenpox vaccine, should be avoided during Blinatumomab treatment. A compromised immune system may struggle to handle the live virus, potentially leading to severe infections.

Blinatumomab in Pregnancy

Is Blinatumomab Safe During Pregnancy?

Blinatumomab is not recommended for use during pregnancy, as it may harm the developing baby by affecting the immune system and interfering with normal fetal development. If you are pregnant or planning to become pregnant, it is crucial to discuss your options with your healthcare provider. They may suggest alternative treatments or recommend postponing therapy until after pregnancy. If you become pregnant while undergoing Blinatumomab treatment, contact your provider immediately to determine the safest course of action for both you and your baby.

Blinatumomab While Breastfeeding

Can You Take Blinatumomab While Breastfeeding?

It is not yet known whether Blinatumomab passes into breast milk. However, due to the potential for serious side effects in nursing infants, breastfeeding is generally not recommended during treatment. If you are currently breastfeeding or planning to breastfeed, consult your healthcare provider to weigh the risks and benefits. They may advise you to stop breastfeeding during treatment or explore alternative feeding options for your baby.

Estimated Cost of Blinatumomab Treatment

Blinatumomab treatment can be costly, particularly for individuals without insurance coverage. The estimated cost for a 30-day supply is approximately $178,000 when using a GoodRx coupon. However, prices may vary depending on the pharmacy and location. To better understand your financial options, consult your healthcare provider or pharmacist. They can provide specific pricing details and help you explore potential financial assistance programs that may reduce the cost of treatment.

Possible Alternatives to Blinatumomab Treatment

If Blinatumomab is not the right option for you or if you are considering other treatments, there are several alternatives available depending on the specific type of acute lymphoblastic leukemia (ALL) you have. It is crucial to discuss any potential changes to your treatment plan with your healthcare provider. You may also schedule a telemedicine appointment with one of our specialists to explore these options in greater depth.

Alternative Treatments for Acute Lymphoblastic Leukemia (ALL)

Chemotherapy: Traditional chemotherapy remains a foundational treatment for ALL. Medications such as vincristine, daunorubicin, and methotrexate work by targeting rapidly dividing cancer cells, helping to slow or stop their growth.

Targeted therapies: For patients with Philadelphia chromosome-positive ALL, targeted therapies like imatinib (Gleevec) or dasatinib (Sprycel) can be highly effective. These drugs specifically target the abnormal proteins that drive cancer progression.

Stem cell transplant: In certain cases, a stem cell transplant may be recommended. This procedure involves replacing damaged bone marrow with healthy stem cells, offering the potential for a long-term cure in some patients.

Treatment Options for Minimal Residual Disease-Positive ALL

Tyrosine kinase inhibitors (TKIs): For patients with Philadelphia chromosome-positive ALL, TKIs such as imatinib (Gleevec) or dasatinib (Sprycel) are often used to effectively target and eliminate residual cancer cells.

CAR T-cell therapy: This groundbreaking immunotherapy involves modifying your immune cells to better recognize and attack leukemia cells. CAR T-cell therapy has shown remarkable promise in treating minimal residual disease-positive ALL.

Options for Relapsed or Refractory ALL

CAR T-cell therapy: For patients whose leukemia has returned after initial treatment, CAR T-cell therapy offers an advanced option. This approach reprograms immune cells to identify and destroy cancer cells more effectively.

Inotuzumab ozogamicin (Besponsa): This targeted therapy delivers a chemotherapy agent directly to leukemia cells, reducing harm to healthy cells. It is a valuable option for patients with relapsed or refractory ALL.

Recent Updates on Blinatumomab Research

Recent studies have highlighted the effectiveness of Blinatumomab in treating specific forms of acute lymphoblastic leukemia, particularly in patients with minimal residual disease (MRD). One study found that patients with MRD-positive ALL who received Blinatumomab experienced significantly improved survival rates compared to those who did not receive the medication. These findings emphasize the potential of Blinatumomab to improve outcomes for certain ALL patients.

Ongoing research is also investigating the use of Blinatumomab in combination with other therapies, such as CAR T-cell therapy, to enhance its effectiveness. This combination approach could pave the way for new strategies to treat various subtypes of ALL.

As research continues, new discoveries may further expand the role of Blinatumomab in managing acute lymphoblastic leukemia. Be sure to discuss the latest advancements with your healthcare provider. You can also schedule a telemedicine appointment with one of our specialists to stay informed about the most effective treatment options for your condition.

James Kingsley

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