Ambulatory Blinatumomab infusion: information for parents/carers

Patient name:

NHS number:

About Blinatumomab

Blinatumomab is a type of cancer drug called a monoclonal antibody. It works by seeking out cancer cells by “looking” for a particular protein on the cells’ surface. The immune system can then recognise the cancerous cells, and attack and kill them.

The medicine is administered as a continuous infusion via a pre-programmed electronic pump, which can be carried in a small belt bag. The treatment is continuous over 28 days. This treatment is always started in hospital and children will only be considered for discharge if deemed safe to do so.

Your child has been risk assessed by their clinical team at CUH as suitable for ambulatory care, either at home or within Kingston House on the hospital site. The infusion will run continuously during this time, 24 hours per day. You will not be expected to change the pump settings. Prior to discharge from C2 you will be advised on the action required in the event of pump alarms, caring for the IV tubing and battery maintenance. The medicine needs to be changed every 3 or 4 days and you will be given an appointment for this in PDU or C2. During this appointment your child will also be reviewed by a doctor.

Whilst your child is an outpatient receiving Blinatumomab, you will have access to the clinical team 24 hours a day. You can telephone the number provided below with any concerns about your child or the pump. A nurse will discuss your concerns and triage, giving advice or escalating to a haematology / oncology consultant as appropriate. If the triage nurse advises face-to-face assessment, you will be asked to come to C2 / PDU immediately or a local hospital as appropriate

If you have any concerns regarding your child or the Blinatumomab infusion please telephone for advice on this telephone triage number:

01223 217547

Emergency admission

If your child is taken in an emergency to their local hospital by ambulance, this will be to provide immediate stabilisation. Once stable, your child will be transferred to CUH for continued management by the Paediatric Haematology and Oncology team.

Please show this sheet to any attending nurse or doctor to ensure the Blinatumomab line is not used for administration of emergency treatment.

Do not flush the Blinatumomab line as this will result in a bolus dose of Blinatumomab being administered, which may be dangerous.

Instructions for emergency management of Blinatumomab

• Telephone CUH for advice: 24 hour telephone triage line: 01223 217547
• The line containing Blinatumomab must not be flushed without being first aspirated to remove any medication in the line. Accidental bolus of this medication is dangerous.

Instructions for emergency discontinuation

Stop and clamp Blinatumomab line (this may be sufficient prior to transfer).

Only if neccessary

Aspirate 2-3mL (to prevent further administration of Blinatumomab in the line).

Only then can the line be flushed with 0.9% sodium chloride.

Like all medicines, Blinatumomab can cause side effects, although not all patients experience these. Please contact the hospital if you are concerned that your child is experiencing any possible side effects.

Signs and symptoms of possible serious side effects of Blinatumomab

• Infection due to risk of neutropenia: chills, shivering, temperature of <36° Celsius or ≥38° Celsius, a rapid heart rate, decreased blood pressure, aching muscles, feeling tired, coughing, difficulty breathing, confusion, redness, swelling or discharge in the affected area or at the site of the infusion line.
• Neurological events: shaking (or tremor), confusion, disturbances of brain function (encephalopathy), difficulty in communicating (aphasia), seizure (convulsion), dizziness, balance/coordination disorders.
• Cytokine release syndrome: characterized by fever, swelling, chills, decreased or increased blood pressure and fluid in the lungs, which may become severe.
• Pancreatitis: abdominal pain, fever, jaundice.

Other very common side effects of Blinatumomab include:

• Infections
• Reduced number of white blood cells which may result in general weakness and a tendency to develop infections
• Reduced number of red blood cells which may result in feeling tired and short of breath
• Reduction in the number of various types of blood cells
• Unable to sleep
• Shaking, tremors
• Headache
• Rapid heart rate
• Low blood pressure
• Cough
• Nausea
• Gastrointestinal disorders (diarrhoea, constipation, pain in the abdomen)
• Vomiting
• Rash
• Back pain, pain in extremity
• Decreased appetite
• Fever
• Chills
• Swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing (oedema)
• Low levels of antibodies (called immunoglobulins) which help the immune system fight infection (decreased immunoglobulins)
• Abnormalities of liver tests which may result in a yellowish colour of the skin and eyes
• Reactions related to infusion may include, wheezing, flushing, face swelling, difficulty breathing, low blood pressure, high blood pressure.