Blinatumomab (BLINCYTO®) at Home

Important Information:

Blinatumomab is used to treat acute lymphoblastic leukemia (ALL). It works by slowing or stopping the growth of cancer cells in the body. It is called immunotherapy because it attracts the body's own immune cells to the leukemia cells, so they will attack and kill them.

Blinatumomab is a clear liquid that comes in an intravenous (IV) bag. It is given as a continuous infusion through a central line for 29 days. Your child will have a small, portable infusion pump connected to their central line.

Your child will be admitted to the hospital to start this therapy. They will stay for a few days so that we can monitor them for side effects of the medicine.

Common side effects of blinatumomab

• Nausea, diarrhea

• Headache 

• Tiredness 

• Decreased appetite 

• Weakness 

• Neurologic problems, including seizures 

• Fever

Caretakers at home are responsible for:

• IV bag changes 
  Your home care company will tell you how often the IV bag will be changed at home, typically between 2-7 days. You may be taught to do the bag changes, or this may be done by a home care nurse or a nurse in CHOP's Oncology Clinic.
  
  Your home care company will tell you how to store and dispose of the medicine and any used supplies.

• Port needle changes 
  If your child is receiving blinatumomab through a port, the port needle may be changed at day 6, 7 or 8 so that it is changed at the same time as the bag change. This minimizes interruptions. It will be changed by a home care nurse or a nurse in CHOP's Oncology Clinic. If the needle is to be changed in clinic, remember to bring the bag of medicine with you to the clinic appointment. Remember to check the expiration date.

• Protecting central line dressing and line connections 
  It is important to keep the dressing and line connections clean, dry, and intact. We will teach you how to do this.
  
  You will use a water-resistant dressing such as AquaGuard® to protect the central line dressing and a protective barrier like ValGuard® to protect the line connections.

• Reminders to keep the central line safe:
  If the dressing lifts but the needle or catheter site is still covered with at least a ½” inch border of secure dressing, you can reinforce the dressing once on each side. 
  
  If the dressing has come up completely or port needle or catheter site is exposed, call CHOP or your home infusion company for instructions.

Instructions for a continuous infusion of blinatumomab at home: 

• Do not give acetaminophen (Tylenol®) while your child is on a continuous infusion of blinatumomab without talking to the healthcare team. 

• Do not flush the central line. Flushing can cause an error in the amount of medicine your child receives. 

• If your home care instructs you to flush the line, your home care nurse will instruct you on how to do this. 

• Do not stop or pause the infusion for any reason. 

• It is important to have the blinatumomab infuse continuously as much as possible. When your child needs their blood drawn for labs, they may need to have a needle stick for this instead of taking blood from the central line. If your child needs to have IV medicines in addition to the blinatumomab, they may need to have a peripheral IV in addition to their central line. 

• If the line becomes disconnected from your child's port, do not reconnect the tubing. Clamp the tubing. Call your home care company immediately for a new bag.
  
  If home care cannot hang a new bag promptly, you will need to bring your child to CHOP.

• Weekdays during clinic hours: Bring your child to the Oncology Clinic.

• Evenings after 5:00p.m., holidays, and weekends: Bring your child to the CHOP Emergency Department (ED). 

• If you have an extra bag of blinatumomab at home, bring it with you. Check the expiration date. 

• The infusion will be restarted at CHOP. Your child will be admitted overnight for monitoring if the infusion has been off for more than 8 hours.

  If the infusion ends early, the pump stops working or alarms, or the bag breaks, call your home care company immediately. 

• If home care cannot fix the problem, you will need to bring your child to CHOP's Oncology Clinic during clinic hours or to the CHOP ED after 5:00 p.m. and on weekends and holidays.

Things to know about the infusion

Your child will be able to move around with the pump. We will give you a backpack to carry the pump. Only use the backpack given to you by your homecare company, or a backpack used for enteral feeds that has been approved.

The pump is locked to prevent settings from being accidentally changed.

The new bag must be hung close to the same time with each change. There is very little extra fluid in the bag to allow for a delay.

CADD pump review 

Pump Indicator Lights:

• Green: Flashes when the pump is running and delivering fluid as programmed. 

• Amber: Flashes when the pump is stopped, an alarm condition exists, or the battery or the reservoir volume is low. It stays on continuously when the pump is not operating.

• Note: If both lights are flashing, the pump is running but there is a condition that needs attention.

Pump display:

The display shows programming information and messages. If no keys are pressed after a period of time, the backlight turns off and the display goes blank to save battery power (except during an alarm). Press any key to turn the display back on.

Troubleshooting alarms

“Air-in-line" alarm:

• Select "acknowledge" on pump. If alarm continues, call CHOP or home infusion company for support.

“Downstream occlusion" alarm (blocked between pump and patient): 

• Verify that all clamps are open, trace tubing to check for any kinks. 

• Once occlusion is cleared, the pump will automatically start to run without needing to push any buttons on pump. 

• If alarm continues, call CHOP or home infusion company for support.

“Upstream occlusion" alarm (blocked between pump and reservoir/bag): 

• Trace tubing from Blinatumomab bag to top of pump to check for any kinks. 

• Once occlusion is cleared, the pump will automatically start to run without needing to push any buttons on pump. 

• If alarm continues, call CHOP or home infusion company for support.

Call your CHOP oncology team with questions or concerns, or if: 

• Your child has a fever of 101.3°F (38.5°C) once, or 100.4°F (38°C)- 101.2°F (38.4°C) three times in a 24-hour period, taken at least 2 hours apart. 

• Your child complains of side effects 

• Your home care company cannot fix an infusion problem, and you need to come to the CHOP ED or Oncology Clinic.

If your child shows signs of a life-threatening reaction, call 911. 

Oncology Contact Information

Reviewed October 2024 by Patty Burns-Lynch MSN,RN, CPHON