Blinatumomab
Antineoplastic monoclonal antibodies
Antineoplastic monoclonal antibodiesHigh alert
An error with this medicine can cause serious harm: double checks and protocols are used.
A bispecific antibody that links T cells (CD3) to B-lineage leukaemia cells (CD19) to kill them; used in B-cell ALL. Risks: cytokine release and neurotoxicity.
Also called: bispecific T-cell engager (BiTE)
Quick facts
- Group
- Antineoplastic monoclonal antibodies
- Target
- CD19 on B cells and CD3 on T cells
- Key effects
- Fever · Infusion reactions · Oedema
- Monitor
- Temperature · Neurological checks
- ATC
- L01FX07
No doses: the clinician sets them by the current guideline.
Mechanism of action
Blinatumomab is a small fusion protein made of two antibody binding sites: one for CD19 on normal and malignant B-lineage cells and one for CD3, part of the T-cell receptor complex. It bridges a T cell to the leukaemic cell, independent of MHC antigen presentation, so the T cell releases its cytotoxic granules and kills the CD19-positive cell; T cells proliferate and release cytokines, which explains cytokine release syndrome.
- One arm binds CD19 on leukaemic B cells
- The other arm binds CD3 on T cells
- T cell kills the B cell without MHC presentation
- T-cell activation releases cytokines (CRS risk)
Indications
- B-cell precursor acute lymphoblastic leukaemia: relapsed or refractory, with measurable residual disease, or as consolidation in remission. Acute leukaemia (AML and ALL) →
Adverse effects
Common
- Fever, headache, tremor
- Infusion reactions
- Oedema
- Diarrhoea, mouth sores
- Low neutrophils
Contraindications
- Known allergy to blinatumomab
- Caution: history of seizures or other central nervous system disease
Key interactions
- Live vaccines
- Not given shortly before, during or after treatment until immune recovery.
What is monitored
- Temperature, blood pressure and oxygen during the first days of each cycle (cytokine release)
- Neurological checks: handwriting, speech, orientation
- Blood counts and signs of infection
- Lipase if abdominal pain
Administration and safety
- Continuous intravenous infusion through an infusion pump; the pump, bag and rate are double-checked at every bag change.
- Premedication is given before the start of each cycle and dose step-ups, as ordered.
- The first days of each cycle, and dose increases, are often done in hospital to watch for cytokine release and neurotoxicity.
Pregnancy and breastfeeding
May harm the fetus; contraception is used during treatment and for a period after.
Nursing care
- Vital signs often during the first days of each cycle; report fever, low blood pressure or low oxygen at once.
- Neurological checks each shift (writing a sentence, speech, orientation).
- Protect the line: the infusion is not stopped or changed without instructions.
- Teaching for home infusion: do not drive, report fever, confusion, shaking or trouble speaking, and keep the pump connected.
Pharmacokinetics
- Absorption
- Continuous intravenous infusion through a pump, in cycles of several weeks.
- Elimination
- Broken down as a protein.
Test yourself
Think of the answer, then tap the question to see it.
Which two antigens does blinatumomab bind?
CD19 on B-lineage cells and CD3 on T cells.
What are the two boxed warnings of blinatumomab?
Cytokine release syndrome and neurological toxicity.
How is blinatumomab given?
As a continuous intravenous infusion through a pump, in cycles.
Connections
← Back to the class: Antineoplastic monoclonal antibodies
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Blinatumomab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.