Page 1 INTRAVENOUS CANCER TREATMENT EDUCATION THP BLINATUMOMAB Name of the regimen and cancer drugs Blinatumomab (blin a TOOM oh mab): Blincyto Common uses This regimen is most commonly used for acute lymphoblastic leukemia (ALL) but may be used for other diagnoses. Treatment schedule Your treatment will be given into your vein through an intravenous (IV) line or as a subcutaneous (SubQ) injection. If given IV, this may be into a short, flexible temporary catheter in your arm, or through a central venous catheter. A central venous catheter, or central line is a long, flexible IV tube that empties into a very large vein next to the heart. Talk with your care team to see which will be best for you and your treatment. Each blinatumomab treatment is given as a continuous IV infusion over four weeks repeated every 42 (6 weeks) to 84 days (12 weeks). This is known as one cycle. Your treatment may be given for a set number of cycles, or it will keep going until the drug, or drugs, stop working or you have side effects which stop you from continuing treatment. o Blinatumomab IV given is continuously over Days 1 – 28 (4 weeks on, 2 weeks off) for all cycles when given for MRD+ ALL and for cycles 1 to 5 when used for relapsed/refractory ALL. o Relapsed/refractory ALL Cycle 6 and beyond (4 weeks on, 8 weeks off) BLINATUMOMAB Drug Cycle 1 Day 1 2 3 4 5 6 ... 28 ... 42 Cycle 2 Day 1 Blinatumomab Drug Cycle 6 Day 1 2 3 4 5 6 ... 28 ... 84 Cycle 7 Day 1 Blinatumomab Page 2 INTRAVENOUS CANCER TREATMENT EDUCATION BLINATUMOMAB Other medications Other medications may be ordered for you to prevent or treat certain side effects. These include: Instructions: Medications to prevent tumor lysis syndrome You may receive medications to prevent tumor lysis syndrome before and during your cancer treatment. You may get prescriptions for other medications to take at home, as below: Medications to prevent cytokine release syndrome You will receive medications to prevent a side effect known as cytokine release syndrome before and sometimes during your cancer treatment. You may get prescriptions for other medications to take at home, as below: Infection prevention There is a risk of serious infections during treatment. You may receive medications to prevent infection in the hospital, and may also get prescriptions for medications to take at home for infection prevention, as below: Possible drug interactions o Blinatumomab may interact with other drugs you are taking. Please inform your care providers of all prescription medicine, over-the-counter medications, vitamins, and herbal products that you take. o Talk with your care provider or pharmacist before taking new medications, supplements, or receiving any vaccines. Page 3 INTRAVENOUS CANCER TREATMENT EDUCATION THP BLINATUMOMAB Common Side Effects Common side effects that have been known to happen in patients receiving blinatumomab are listed in the left side of this table. In some instances, the side effects may be reported less often but are still important to discuss. This table does not list all the known side effects for this therapy, only the ones that are experienced most often. Not every patient experiences every known side effect of a drug; even if you are taking the same drug as another patient, you may experience different side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Decreased white blood cells (WBCs) and increased risk for infection Your WBCs should be monitored by a simple blood test. When your WBCs are low, you are at a greater risk of having an infection. Take the following precautions to protect yourself from infection. • Wash your hands often, especially before eating and after using the bathroom. • Avoid crowds and people with fevers, flu, or other infection. • Bathe often for good personal hygiene. Contact your care team if you experience any signs or symptoms of an infection such as: • Fever (temperature more than 100.4°F or 38°C) • Chills • Sore throat • Burning when peeing • Tiredness that is worse than normal • A sore that becomes red, is draining, or does not heal. Check with your care team before taking any medicine for a fever or chills. Continued on the next page Page 4 INTRAVENOUS CANCER TREATMENT EDUCATION BLINATUMOMAB Possible Side Effect Management Decreased platelet count and increased risk of bleeding Your platelets should be monitored by a simple blood test. When they are low, you may bruise or bleed more easily than usual. • Use caution to avoid bruises, cuts, or burns. • Blow your nose gently and do not pick your nose • Brush your teeth gently with a soft toothbrush and maintain good oral hygiene • When shaving use an electric razor instead of razor blades • Use a nail file instead of nail clippers Call your care team if you have bleeding that won’t stop. Examples include: • A bloody nose that bleeds for more than 5 minutes despite pressure • A cut that continues to ooze despite pressure • Gums that bleed a lot when you floss or brush Seek medical help right away if you have any severe headaches, blood in your urine or stool, coughing up blood, or bleeding that you cannot stop or lasts a long time. You may need to take a break or “hold” your medication for medical or dental procedures. Talk to your care team or dentist before any scheduled procedures. Fever You may feel hot, cold and shivery, achy or dizzy. This usually starts during the first month of therapy but could happen at any time. • Call your doctor immediately if you have a fever 100.4º F Ask your doctor if you can take medicine to help with the fever Headache Ask your provider what you may use to help with this discomfort. If your headache is mild, try resting in a dark, quiet room and apply a cool cloth to your forehead. Contact your care team right away if your headache: • Follows a head injury • Is severe, or starts suddenly • Does not go away after 3 days • Is associated with vomiting, visual disturbance, neck stiffness, drowsiness, confusion, made worse by coughing or lowering the head, rash, weakness in an arm or leg, or numbness Page 5 INTRAVENOUS CANCER TREATMENT EDUCATION THP BLINATUMOMAB Rare but serious side effects o Blinatumomab may cause a side effect known as cytokine release syndrome (CRS). During your treatment, let your care team know right away if you develop chills, dizziness, weakness, fevers, rashes, wheezing, have trouble breathing, or feel like you might pass out. o Blinatumomab may cause problems with your nervous system. Let your care team know right away if you develop confusion, a new or worsening tremor, or seizures. Let your care team know right away if you have trouble with your speech, face movements, swallowing, balance, or eyesight. You should not drive while receiving blinatumomab. o Blinatumomab may be harmful to your liver. Speak to your care team to know when you need to have blood tests done to monitor your liver function. If you get this side effect, your doctor may change your dose or stop treatment for some time. o Blinatumomab increases your risk of severe and life-threatening infections. Contact your doctor If you are experiencing any signs or symptoms of an infection including fever and chills, cough, shortness of breath, or fatigue, or if you have any suspicion that you are infected. o Blinatumomab may cause a condition called tumor lysis syndrome when starting treatment. This results from the rapid destruction of cancer cells in the body during the initial cycles of treatment. Your care team may do blood tests to check for this side effect. o Blinatumomab may be harmful to your pancreas. Speak to your care team to know when you need to have blood tests done to monitor your pancreas. Seek medical attention if you have severe abdominal pain or tenderness, fever, or vomiting. If you experience ANY new, worsening, or uncontrolled side effects, call your care team immediately. Page 6 INTRAVENOUS CANCER TREATMENT EDUCATION BLINATUMOMAB Handling body fluids and waste Some of the drugs you receive may be present in urine, stool, sweat, or vomit for many days after treatment. Many cancer drugs are toxic, your bodily waste may also be toxic and can be dangerous to come into contact with. Once you have started blinatumomab, follow the instructions below for at least two days after your treatment. This is to keep you, your loved ones, and the environment as safe as possible. o Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. o Toilet and septic systems • You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low-flow toilet, close the lid and flush twice to ensure that all waste has been discarded. o If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surface after every use before other people use the toliet. o Wash hands with soap and water after using the toilet for at least 20 seconds. o If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. o If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. o Wash any skin that has been exposed to body waste with soap and water. o Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. o Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Intimacy, sexual activity, contraception, and fertility This treatment may cause changes that can affect intimacy and sexuality, including desire and body image. Maintaining physical closeness and/or intimacy with loved ones can be continued during treatment. Holding hands, hugging, and kissing can be done safely. It is recommended that you talk to your care team about any restrictions or questions you may have. Some treatments can influence the ability to have children, also known as fertility. If you’re interested in preserving fertility, talk to your care team before treatment. Ask your healthcare provider to determine when it is safe to become pregnant after your treatment. Patients of reproductive ability should not become pregnant or get their partners pregnant while receiving blinatumomab. Some of the drugs you receive may be present in semen and vaginal secretion for many days after treatment. You should use barrier devices, such as condoms, during sexual activity to limit exposure to body fluids. o Talk to your care team about birth control. Not all options may be right for your treatment or cancer. Effective contraception could include one or more of the following: barrier methods (e.g. condoms), hormone methods (e.g. birth control pills), or surgery. o Tell your care team if you become pregnant or plan to breastfeed. Page 7 INTRAVENOUS CANCER TREATMENT EDUCATION THP BLINATUMOMAB Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the therapy derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this therapy and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this therapy by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual receiving therapy. All decisions related to receiving this therapy should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Intravenous Cancer Treatment Education (IVE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about intravenous cancer therapy. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2023 by NCODA. All rights reserved. Additional resources Product website: https://www.blincyto.com/ Prescribing information: https://www.pi.amgen.com/-/media/Project/Amgen/Repository/pi-amgen-com/blincyto/ blincyto_pi_hcp_english.pdf Product resources: https://www.amgenassist360.com/ Additional instructions Updated – August 26, 2023