Blinatumomab (Blincyto, Amgen) is a bispecific T-cell engager —a monoclonal antibody directed at CD19 (a B-cell marker) as well as CD3 on the surface of cytotoxic T cells. The drug is indicated for the treatment of Philadelphia chromosome–negative B-cell acute lymphoblastic leukemia. It is administered as an IV infusion. In this section, common adverse reactions, warnings and precautions, drug interactions and other contraindications regarding blinatumomab therapy are discussed.
Common adverse reactions
Warnings and precautions
Drug interactions and other contraindications
Blinatumomab common adverse reactions
A life-threatening and potentially fatal reaction, cytokine release syndrome (CRS), has been reported in association with blinatumomab therapy. Cytokine release syndrome may be difficult to distinguish from infusion reactions, which have also been documented with blinatumomab therapy.
Symptoms of CRS include fever, headache, nausea, asthenia, hypotension, elevated liver aminotransferases (ALT and AST) and elevated total bilirubin. In certain severe cases of CRS, the following have been reported:
- disseminated intravascular coagulation (a condition in which tiny clots form in vessels throughout the body, creating blockages in small vessels; platelets and coagulation factors are consumed during the formation of these numerous small clots, which results in hemorrhage);
- pancreatitis (inflammation of the pancreas, which can lead to hemorrhage and even death);
- elevated liver enzymes;
- neutropenia and febrile neutropenia; and
- neurological reactions, including seizure.
Blinatumomab warnings and precautions
Because of the risk for seizure and other neurological effects, patients should refrain from driving or participating in potentially hazardous activities while being treated with blinatumomab.)
Blinatumomab drug interactions and other contraindications
Patients should not receive any live viral vaccines before, during or after blinatumomab therapy, until they have recovered sufficient immune function.
Blinatumomab therapy is contraindicated in patients with known sensitivities to any component of the preparation.