Blincyto Generic Name & Formulations
Legal Class
General Description
Pharmacological Class
How Supplied
Manufacturer
Generic Availability
Mechanism of Action
Blincyto Indications
Indications
Blincyto Dosage and Administration
Adults and Children
Strictly follow preparation and administration instructions. Give by continuous IV infusion at a rate of 10mL/hr over 24hrs, 5mL/hr over 48hrs, or 0.6mL/hr over 7 days (not recommended for patients <22kg). MRD-positive: premedicate with prednisone 100mg IV or equivalent (adults) 1hr prior to 1st dose of each cycle, or dexamethasone 5mg/m2 to max 20mg (pediatrics) prior to 1st dose in the 1st cycle, and when restarting infusion after interruption (≥4hrs). Treat up to 4 cycles (1 cycle for induction, followed by 3 cycles for consolidation). One single cycle = 28 days of continuous IV infusion followed by a 14-day treatment-free interval (during Cycles 1–4). Hospitalization recommended for first 3 days of Cycle 1 and first 2 days of Cycle 2. <45kg (Cycles 1–4): 15mcg/m2/day (max 28mcg/day) on Days 1–28. ≥45kg (Cycles 1–4): 28mcg/day on Days 1–28. Relapsed/refractory: premedicate with dexamethasone 20mg (adults) 1hr prior to 1st dose of each cycle, or dexamethasone 5mg/m2 to max 20mg (pediatrics) prior to 1st dose in the 1st cycle, plus prior to a step dose, and when restarting infusion after interruption (≥4hrs) for both adults and pediatrics. Treat up to 9 cycles (2 cycles for induction, followed by 3 cycles for consolidation, and up to 4 additional cycles of continued therapy). One single cycle = 28 days of continuous IV infusion followed by a 14-day treatment-free interval (during Cycles 1–5) and 56-day treatment-free interval (during Cycles 6–9). Hospitalization recommended for first 9 days of Cycle 1 and first 2 days of Cycle 2. <45kg (Cycle 1): 5mcg/m2/day (max 9mcg/day) on Days 1–7 and 15mcg/m2/day (max 28mcg/day) on Days 8–28; (Cycles 2–9): 15mcg/m2/day (max 28mcg/day) on Days 1–28. ≥45kg (Cycle 1): 9mcg/day on Days 1–7 and 28mcg/day on Days 8–28; (Cycles 2–9): 28mcg/day on Days 1–28. Dose adjustments, using 24-hr, 48-hr, or 7-day infusion of Blincyto: see full labeling.
Other Modifications
Dosage Modifications for Adverse Reactions
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If the interruption after an adverse reaction is ≤7 days, continue the same cycle to a total of 28 days of infusion inclusive of days before and after the interruption in that cycle. If an interruption due to an adverse reaction is >7 days, start a new cycle.
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Cytokine Release Syndrome (CRS) - Grade 3
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<45 kg: Interrupt Blincyto. Give dexamethasone 5 mg/m2 (max 8 mg) every 8 hours IV or orally for up to 3 days then taper over 4 days. Once CRS is resolved, restart Blincyto at 5 mcg/m2/day, and escalate to 15 mcg/m2/day after 7 days if adverse reaction does not recur.
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≥45 kg: Interrupt Blincyto. Give dexamethasone 8 mg every 8 hours IV or orally for up to 3 days then taper over 4 days. Once CRS is resolved, restart Blincyto at 9 mcg/day, and escalate to 28 mcg/day after 7 days if adverse reaction does not recur.
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CRS - Grade 4
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Discontinue Blincyto permanently. Give dexamethasone as instructed for Grade 3 CRS.
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Neurological Toxicity - Seizure
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Discontinue Blincyto permanently if more than 1 seizure occurs.
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Neurological Toxicity - Grade 3
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<45 kg: Withhold Blincyto until no more than Grade 1 (mild) and for at least 3 days, then restart at 5 mcg/m2/day. Escalate to 15 mcg/m2/day after 7 days if adverse reaction does not recur. If adverse reactions occurs at 5 mcg/m2/day, or if adverse reactions takes more than 7 days to resolve, discontinue permanently.
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≥45 kg: Withhold Blincyto until no more than Grade 1 (mild) and for at least 3 days, then restart at 9 mcg/day. Escalate to 28 mcg/day after 7 days if adverse reaction does not recur. If adverse reactions occurs at 9 mcg/day, or if adverse reactions takes more than 7 days to resolve, discontinue permanently.
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Neurological Toxicity - Grade 4
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Discontinue permanently.
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Other Clinically Relevant Adverse Reactions - Grade 3
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<45 kg: Withhold Blincyto until no more than Grade 1 (mild), then restart at 5 mcg/m2/day. Escalate to 15 mcg/m2/day after 7 days if adverse reaction does not recur. If adverse reaction takes more than 14 days to resolve, discontinue permanently.
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≥45 kg: Withhold Blincyto until no more than Grade 1 (mild), then restart at 9 mcg/day. Escalate to 28 mcg/day after 7 days if adverse reaction does not recur. If adverse reaction takes more than 14 days to resolve, discontinue permanently.
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Other Clinically Relevant Adverse Reactions - Grade 4
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Consider discontinuing permanently.
Administration
Preparation and Administration of Blincyto (see full labeling)
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It is very important that the instructions for preparation (including admixing) and administration provided in this section are strictly followed to minimize medication errors (including underdose and overdose).
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Blincyto can be infused over 24 hours (preservative-free), 48 hours (preservative-free), or 7 days (with preservative). The choice between these options for the infusion duration should be made by the treating healthcare provider considering the frequency of the infusion bag changes and the weight of the patient.
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The administration of Blincyto as a 7-day infusion is not recommended for patients weighing <22 kg.
Blincyto Contraindications
Not Applicable
Blincyto Boxed Warnings
Boxed Warning
Cytokine release syndrome. Neurological toxicities, including immune effector cell-associated neurotoxicity syndrome (ICANS).
Blincyto Warnings/Precautions
Warnings/Precautions
Monitor for cytokine release syndrome, neurological toxicities including ICANS (eg, seizures, loss of consciousness), tumor lysis syndrome; interrupt or discontinue as recommended (see full labeling). Monitor for infections; give antibiotic prophylaxis as appropriate. Obtain lab tests (including WBC, ANC) during infusion; interrupt if prolonged neutropenia occurs. Monitor ALT, AST, GGT, and total bilirubin prior to and during treatment; interrupt if transaminases rise >5×ULN or if bilirubin rises >3×ULN. Evaluate if signs/symptoms of pancreatitis develop; interrupt or discontinue as appropriate. Risk of leukoencephalopathy, esp. in those with prior treatment with cranial irradiation and antileukemic chemotherapy (including high-dose methotrexate or intrathecal cytarabine). Elderly. Neonates/infants: risk of gasping syndrome (due to benzyl alcohol preservative); monitor for metabolic acidosis. Embryo-fetal toxicity. Pregnancy: exclude status prior to initiation. Advise females of reproductive potential to use effective contraception during and for ≥48hrs after the last dose. Nursing mothers: not recommended (during and for ≥48hrs after the last dose).
REMS
Blincyto Pharmacokinetics
Distribution
The estimated mean (SD) volume of distribution based on terminal phase (Vz) was 4.35 (2.45) L with continuous intravenous infusion of blinatumomab.
Elimination
The estimated mean (SD) systemic clearance with continuous intravenous infusion in patients receiving blinatumomab in clinical studies was 3.11 (2.98) L/hour. The mean (SD) half-life was 2.10 (1.41) hours. Negligible amounts of blinatumomab were excreted in the urine at the tested clinical doses.
Blincyto Interactions
Interactions
Blincyto Adverse Reactions
Adverse Reactions
Blincyto Clinical Trials
Blincyto Note
Not Applicable
Blincyto Patient Counseling
Cost Savings Program
Blincyto Support and Resources: https://www.blincyto.com/relapsed-refractory/support-and-resources