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Chemotherapy and other systemic treatment regimens may change due to COVID-19. Find out more at Systemic Treatment Regimens During COVID-19.

blinatumomab

( blin-a-too-moo-mab )
Funding:
New Drug Funding Program
  • Blinatumomab - Relapsed or Refractory Acute Lymphoblastic Leukemia (Ph+ BCP-ALL)
  • Blinatumomab - Relapsed or Refractory Acute Lymphoblastic Leukemia (Ph- BCP-ALL)
  • Blinatumomab - Minimal Residual Disease (MRD)-Positive B-cell Precursor Acute Lymphoblastic Leukemia
  • Blinatumomab - Relapsed or Refractory Pediatric Acute Lymphoblastic Leukemia
Other Name(s): Blincyto®
Appearance: solution mixed into larger bags of fluids

Medication Information Sheet
blinatumomab (blin-a-too-moo-mab)
This document provides general information about your medication. It does not replace the advice of your health care professional. Always discuss your therapy with your health care professional and refer to the package insert for more details.

Other Name: Blincyto®

Appearance:
solution

mixed into larger bags of fluids

What is this medication for?
  • For treating a type of blood cancer called acute lymphoblastic leukemia (ALL). 
What should I do before I have this medication?
  • Tell your health care team if you have or had significant medical condition(s), especially if you have / had: 

    • Neurological problems, for example, nerve problems or seizures

    • Previous radiation and chemotherapy for leukemia or,

    • Any allergies
       

Remember to:

  • Tell your health care team about all of the other medications you are taking.
  • Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
How will this medication affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

  • How this medication may affect your sexual health.
  • How this medication may affect your ability to have a baby, if this applies to you.

This medication may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
 

  • If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time until 48 hours after your last treatment dose. Talk to your health care team about which birth control options are best for you.
     
  • Do not breastfeed while on this medication and for at least 48 hours after the last dose.
How is this medication given?
  • Blinatumomab is given as injection through IV (injected into a vein). Your infusion will start on day 1 at the hospital and continue there until your health care team decides it is ok for you to continue at home. You will receive a continuous infusion of blinatumomab for 28 days followed by 2 weeks off (when the medication is not given). Talk to your health care team about your treatment schedule

  • You will be given this treatment along with other medications to help prevent a reaction and some side effects.


To Prevent Tumor Lysis Syndrome (TLS)

TLS can happen when a large number of cancer cells die quickly and your body cannot get rid of them fast enough. TLS can make you very sick. Ask your health care team if you are at risk for TLS.

If you are at risk for TLS, you may be given medications before your blinatumomab treatment to help prevent it.

These are called anti-uricemics (such as allopurinol), or others.


To Prevent Allergic Reaction

You will be given a corticosteroid (such as dexamethasone) before your treatment to help prevent allergic reactions before they start.

What else do I need to know while on this medication?
  • Will this medication interact with other medications or natural health products?

    • This medication can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.

    • Tell your health care team about all of your:

      • prescription and over-the-counter (non-prescription) medications and all other drugs, such as cannabis/marijuana (medical or recreational)

      • natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements

    • Check with your health care team before starting or stopping any of them.
       

  • If you are taking a blood thinner (such as warfarin), your health care team may need extra blood tests and may change your dose.

  • What should I do if I feel unwell, have pain, a headache or a fever?

    • Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).

      • Fever can be a sign of infection that may need treatment right away.

      • If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
         

    How to check for fever:

    Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

    • You have a fever if your temperature taken in your mouth (oral temperature) is:
       
      • 38.3°C (100.9°F) or higher at any time

        OR
         
      • 38.0°C (100.4°F) or higher for at least one hour.


    If you do have a fever:

    • Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
    • Ask your health care team for the Fever pamphlet for more information. 
       

    If you do not have a fever but have mild symptoms such as headache or mild pain:

    • Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.

    • Talk to your health care team before you start taking Ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.

    • Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
       

What to DO while on this medication: 

  • DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
     

  • DO tell your health care team about any serious infections that you have now or have had in the past
     

What NOT to DO while on this medication:

  • DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

  • DO NOT drive, operate machinery or do any tasks that need you to be alert if you feel dizzy, confused or experience seizures while on blinatumomab,

What are the side effects of this medication?

The following table lists side effects that you may have when getting blinatumomab. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on blinatumomab.

Common Side Effects (25 to 49 out of 100 people)
Side effects and what to do When to contact health care team

Fever, chills

You have a fever if your temperature taken in your mouth (oral temperature) is:

  • 38.3°C (100.9°F) or higher at any time

            OR

  • 38.0°C (100.4°F) or higher for at least one hour.

When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information.

What to look for?

  • If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever.
  • Do not take medications that treat a fever before you take your temperature (for example, Tylenol® (acetaminophen), or Advil® (ibuprofen)).
  • Do not eat or drink anything hot or cold right before taking your temperature
  • You may have fever, chills and muscle pain without any signs of infection, such as a sore throat, cough or skin rash.
  • It may happen at any time after you receive your treatment and it usually goes away as your body gets used to the medication.


What to do?

If your health care team has told you that you have low neutrophils:

  • Wash your hands often to prevent infection.
  • Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist.
  • Keep a digital thermometer at home so you can easily check for a fever.

If you have a fever:

If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.

Low platelets in the blood

When platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information.
 

What to look for?

  • Watch for signs of bleeding:
    • bleeding from your gums
    • unusual or heavy nosebleeds
    • bruising easily or more than normal
    • black coloured stools (poo) or blood in your stools (poo)
    • coughing up red or brown coloured mucus
    • dizziness, constant headache or changes in your vision
    • heavy vaginal bleeding 
    • red or pink coloured urine (pee)

What to do?

If your health care team has told you that you have low platelets:

  • Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
  • Check with your healthcare team before you go to the dentist.
  • Take care of your mouth and use a soft toothbrush.
  • Try to prevent cuts and bruises.
  • Ask your health care team what activities are safe for you.
  • Your treatment may have to be delayed if you have low platelets. Your health care team may recommend blood transfusion.

If you have signs of bleeding:

  • If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes.

If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.

Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe, you MUST get emergency medical help right away. 

Allergic reaction

(May be severe)

What to look for?

  • Fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness.
  • It may happen during or shortly after your treatment is given to you and may be severe.


What to do?

  • Tell your nurse right away if you feel any signs of allergic reaction during or just after your treatment.
  • Talk to your health care team for advice if you have a mild skin reaction.

 

Get emergency medical help right away for severe symptoms

Headache; mild joint, muscle pain or cramps 

What to look for?

  • Mild headache
  • New pain in your muscles or joints, muscle cramps, or feeling achy.
     

What to do?

  • Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed.
  • Read the above section: "What should I do if I feel unwell, have pain, a headache or a fever?" before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding.
  • Rest often and try light exercise (such as walking) as it may help.

Ask your health care team for the Pain pamphlet for more information.

Talk to your health care team if it does not improve or if it is severe

 

Less Common Side Effects (10 to 24 out of 100 people)
Side effects and what to do When to contact health care team

Liver problems

Your health care team may check your liver function with a blood test. Liver changes do not usually cause any symptoms.


What to look for?

  • Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe.

What to do?

If you have any symptoms of liver problems, get emergency medical help right away.

Get emergency medical help right away

Mild swelling

What to look for?

  • You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe.
     

What to do?

To help prevent swelling:

  • Eat a low-salt diet.

If you have swelling:

  • Wear loose-fitting clothing.
  • For swollen legs or feet, keep your feet up when sitting.
Talk to your health care team if it does not improve or if it is severe

Cough and feeling short of breath

What to look for?

  • You may have a cough and feel short of breath.
  • Symptoms that commonly occur with a cough are:
    • wheezing or a whistling breathing
    • runny nose
    • sore throat
    • heartburn
    • weight loss
    • fever and chills
  • Rarely this may be severe with chest pain, trouble breathing or coughing up blood.

What to do?

  • Check your temperature to see if you have a fever. Read the above section "What should I do if I feel unwell, have pain, a headache or a fever?".
  • If you have a fever, try to talk to your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
  • If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away.
Talk to your health care team. If you are not able to talk to your health care team for advice, and you have a fever or severe symptoms, you MUST get emergency medical help right away

Rash; dry, itchy skin

What to look for?

  • You may have cracked, rough, flaking or peeling areas of the skin.
  • Your skin may look red and feel warm, like a sunburn.
  • Your skin may itch, burn, sting or feel very tender when touched.

What to do?

To prevent and treat dry skin:

  • Use fragrance-free skin moisturizer.
  • Protect your skin from the sun and the cold.
  • Use sunscreen with UVA and UVB protection and a SPF of at least 30.
  • Avoid perfumed products and lotions that contain alcohol.
  • Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less.

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

Talk to your health care team if it does not improve or if it is severe

Cytokine release syndrome

(May be severe)

What to look for?

  • Fever, along with:
    • swelling
    • chills
    • low or high blood pressure (for example, dizziness or severe headache), and/or
    • difficulty breathing
  • Usually happens soon after treatment begins (within hours)

What to do?

Get emergency medical help right away.
Get emergency medical help right away

Low blood pressure

What to look for?

  • You may feel tired, dizzy or light-headed.
  • You may have nausea (feeling like you need to throw up), vomiting or blurred vision.
  • You may faint (pass out).
     

What to do?

  • Check your blood pressure often. Talk to your health care team to find out what a safe blood pressure is for you.
  • If you feel dizzy or unwell lay down right away so that you do not fall. Try to get up and move slowly only once you feel better.
  • Do not drive a motor vehicle or operate machinery if you feel dizzy.
  • Your blood pressure may drop while you are on this medication. Let your health care team know right away if you start to feel dizzy or lightheaded.
Talk to your health care team if it does not improve or if it is severe

Trouble Sleeping

Your medications may cause trouble sleeping. It may get better once your body gets used to the medication or when your treatment ends.
 

What to look for?

  • You may find it hard to fall asleep or stay asleep.
  • How well you sleep may change over your treatment. For example, you may have several nights of poor sleep followed by a night of better sleep.
  • You may wake up too early or not feel well-rested after a night's sleep.
  • You may feel tired or sleepy during the day.
     

What to do?

Talk to your health care team if it does not improve or if it is severe

Talk to your health care team if it does not improve or if it is severe

Tremors (shaking)

What to look for?

  • shaky movements in one or more parts of the body that you cannot control

What to do?

Talk to your health care team if it does not improve or if it is severe.
Talk to your health care team if it does not improve or if it is severe

 

Other rare, but serious side effects are possible. If you experience ANY of the following, speak to your health care provider or get emergency medical help right away:

  • Severe headache, dizziness, passing out, confusion, hallucinations.

  • Seizures

  • New changes in your senses, such as hearing, trouble with face movements or swallowing

  • Muscle twitching, severe weakness or cramping, irregular heartbeat

  • New lower back pain, changes in urination (peeing) such as less urine (pee) than usual

  • Sudden increase in body weight or swelling in legs or feet, swollen lymph nodes

  • Severe belly pain, including pain in the centre of your belly that may extend to your back

 

Who do I contact if I have questions or need help?          

My cancer health care provider is: ______________________________________________

During the day I should contact:________________________________________________

Evenings, weekends and holidays:______________________________________________

 

Other Notes:

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March 2022 Updated/Revised info sheet

For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.