Blinatumomab (Blincyto)

Blinatumomab is a targeted cancer drug. It is also known as Blincyto.

It is a treatment for a type of acute lymphoblastic leukaemia (ALL) called precursor B cell ALL.

You pronounce blinatumomab as blih-nuh-too-moh-mab.

How does blinatumomab work?

Blinatumomab belongs to a group of targeted drugs called monoclonal antibodies. It works by targeting a certain protein on the leukaemia cells so your immune system can recognise them. The protein is called CD19. The immune system can then attack and kill the leukaemia cells. 

How do you have blinatumomab?

You have blinatumomab as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

How often do you have blinatumomab?

You have blinatumomab as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

A cycle is a continuous drip of blinatumomab over 4 weeks (28 days). You then have a 2 week break with no drip.

You have up to 5 cycles of blinatumomab. This depends on how your cancer responds to the treatment and how bad the side effects are.

You usually start the treatment in hospital and then go home with the drip after a couple of days or weeks. You usually have the infusion through a small portable pump connected to either your central line, PICC line or portacath. You can carry the pump on a belt or in a bag.

Before starting blinatumomab you have a steroid. This is to prevent a reaction to blinatumomab.

The team looking after you will tell you more about this.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of blinatumomab?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Reaction to the infusion 

Some people have an allergic reaction to blinatumomab. This reaction is most likely to happen in the first 48 hours of having this drug. Symptoms include fever, chills, muscle pain, rash, facial swelling or difficulty breathing. 

Increased risk of getting an infection 

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Swelling

This drug can cause a build up of fluid in different parts of your body such as your face, hands, and feet. Let your medical team know if you have any swelling.

Skin problems

Skin problems include redness of the skin or a rash, that may be itchy or bumpy. This usually goes back to normal when your treatment finishes.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Feeling shaky (tremors)

You may develop shakes (tremors) with this treatment. This could be an early sign that the treatment is affecting your nervous system. Let your team know if you start to feel shaky.

Cough 

Blinatumomab can cause irritation of the lungs, causing you to cough. Less commonly you might bring up mucus (phlegm). Let your medical team know if you have a cough. 

Pain in your tummy (abdomen) or other parts of your body

Tell your treatment team if you have this. They can work out the cause and give you medicine to help relieve the pain. 

Changes to your blood pressure

You might develop high or low blood pressure. 

Tell your doctor or nurse if you feel lightheaded or dizzy. You have your blood pressure checked regularly.

Low levels of antibodies called immunoglobulins

Immunoglobulins are antibodies made by the immune system to fight infection. You have regular blood tests during and after treatment to check this. 

Cytokine release syndrome

Cytokines are a group of proteins in the body that play an important part in boosting the immune system. Blinatumomab stimulates the immune system to make large amounts of cytokines. This can cause symptoms which can be severe. Some of the symptoms include fever, chills, a headache, difficulty breathing, and dizziness.

Rarely this can be life threatening. 

Fast heartbeat

You may feel that your heart is beating very quickly. This can make you feel dizzy, breathless and tired.

Difficulty sleeping

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Diarrhoea or constipation 

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

High temperature or chills

You might get a high temperature. Or you might feel cold or start shivering (chills). 

Contact your advice line straight away if you have signs of infection, including a temperature above 37.5C or below 36C.

Occasional side effects

These side effects happen between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• changes to levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) – you will have regular blood tests to check for this

• dizziness

• confusion

• difficulty communicating or controlling movements

• tingling of the skin (paraesthesia)

• seizures (fits)

• memory problems such as difficulty remembering, thinking or processing thoughts

• feeling very sleepy

• numbness

• nerve problems that affect your vision, the muscles in your face, or swallowing

• high blood pressure

• episodes of feeling warm and reddening of the skin (flushing)

• breathing problems such as shortness of breath or wheezing

• gaining weight

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• swollen lymph nodes (glands)

• too many of a type of white blood cell that can cause tissue damage

• difficulty speaking

• a condition that causes fluid to leak from the small blood vessels into your body (capillary leak syndrome)

• inflammation of the pancreas - symptoms include pain in your tummy, feeling or being sick, indigestion, fast heartbeat, fever or yellowing of the skin or whites of the eyes (jaundice)

• feeling very short of breath

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 48 hours afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations 

Having immunisations - Don’t have immunisations with live vaccines at least 2 weeks before, while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

• have other vaccines, but they might not give you as much protection as usual
• have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.