Blinatumomab (Blincyto®) may be used to treat a type of acute lymphoblastic leukaemia (ALL), called B-lymphoblastic leukaemia, which is Philadelphia chromosome negative and CD19 positive. Blinatumomab may be used if ALL has not completely gone after chemotherapy treatment or has come back (relapsed).
Blinatumomab is a type of targeted therapy called an immunotherapy drug. It may also be called a monoclonal antibody. It works with the immune system to target proteins on the surface of the leukaemia cells. These are called CD19 proteins. Blinatumomab helps the immune system recognise and attack the leukaemia cells.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You usually have blinatumomab during a stay in hospital.
During treatment, you usually see a cancer doctor, a cancer nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
You will have regular blood tests during your treatment. A nurse or person trained to take blood (phlebotomist) will take the blood samples from you. You will also have a blood test a few days before or on the day of treatment. This is to check that your blood test results are at a safe level to have treatment. If they are not, your treatment may be delayed for a short while.
You will see a doctor or nurse before you have treatment. They will talk to you about your blood results and ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your immunotherapy treatment.
You have blinatumomab through a drip into a vein. This is called having an intravenous infusion. You will usually have a central line, PICC line or port put in. These types of lines can stay in place for several months while you have your treatment, and you can go home with them.
Your course of treatment
Blinatumomab is given in cycles of treatment. Each cycle takes 42 days (6 weeks). You have a continuous drip (infusion) of blinatumomab for 28 days (4 weeks). This is followed by a break from treatment for 14 days (2 weeks).
You may have up to 5 cycles of blinatumomab. The number of cycles you have will depend on:
- how the leukaemia responds to the treatment
- the side effects you get.
Before starting blinatumomab, you have a steroid called dexamethasone. For the first few days of treatment, you will usually stay in hospital to be monitored. You may be allowed to go home after this to continue the infusion at home.
You usually have the infusion through a small portable pump connected to either a central line, PICC line or port. You can carry the pump on a belt or in a bag. The nurses will tell you how to look after it.
Your nurse, pharmacist or doctor will discuss your treatment plan with you.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
Sometimes side effects can become serious very quickly. It is important to contact the hospital straight away if you have new symptoms or side effects.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Some people may have side effects while they are being given this treatment.
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Effects on the nervous system
Blinatumomab can affect the nervous system. You may experience:
- fits (seizures), although these are rare.
Tell your doctor or nurse straight away if you have any of these symptoms. They may make some changes to your treatment.
It is important not to drive or operate machinery if you have these side effects.
Effects on the immune system (cytokine release syndrome – CRS)
Immunotherapies cause the immune system to release proteins in the body. These proteins are called cytokines. High levels of cytokines may cause inflammation throughout the body. This is called cytokine release syndrome (CRS). It can affect some of the body’s functions.
Symptoms of CRS include:
- flu-like symptoms
- a skin rash
- joint or muscle aches
- low blood pressure
- shortness of breath.
Tell your doctor or nurse straight away if you have any of these symptoms. They will stop the blinatumomab infusion and treat any symptoms you have.
The nurses will give you anti-sickness drugs regularly to help prevent or control sickness during your treatment. If you feel sick or are sick (vomit), tell your nurse or doctor. They may change the anti-sickness drug to one that works better for you.
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
Tummy (abdominal pain)
Raised levels of uric acid (tumour lysis syndrome)
This treatment may cause the cancer cells to break down quickly. This releases a waste product called uric acid into the blood. The kidneys usually get rid of uric acid but may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints. This is called gout. It may also cause other effects such as:
- kidney problems
- an abnormal heartbeat
- seizures, although these are rare.
Your doctor may give you drugs to help prevent this. Drinking at least 2 litres (3½ pints) of fluids a day will also help. You will have regular blood tests to check the uric acid levels.
This treatment may affect your skin. It may cause a rash, which might be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.
Always tell your doctor or nurse about any changes to your skin. They can give you advice and may prescribe creams or medicines to help. Skin changes usually improve when treatment finishes.
Effects on the heart
Blinatumomab can affect the way the heart works and cause your heart to beat too quickly. You may have tests to see how well your heart is working, before, during, and sometimes after treatment.
Tell your doctor straight away if you feel your heart is beating too fast. Other conditions can cause this symptom, but it is important to get it checked by a doctor.
Effect on your blood pressure
Back or bone pain
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
Liver and pancreas changes
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
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