(58) Blinatumomab Without Borders: Taking Life-Saving Treatment Home

Title: Blinatumomab Without Borders: Taking Life-Saving Treatment Home

Abstract : Blinatumomab administration has become a standard treatment for acute lymphoblastic leukemia (ALL), following promising early outcomes from the AALL1731 study. The randomized groups in this trial demonstrated a 3-year disease-free survival (DFS) rate of 96% in those receiving blinatumomab, compared to 87.9% in the non-blinatumomab arms. Blinatumomab is administered in two non-consecutive 28-day blocks with ideally approximately 24 days of treatment at home.
The staff at the Center for Cancer and Blood Disorders (CCBD) at Children’s Health faced a significant challenge due to the volume and urgency of the therapy to start. We had about 44 patients needing 2 courses over the next 4 months. Nursing leadership brought together key stakeholders in nursing and pharmacy to analyze the various components required to safely discharge patients home on a continuous infusion and educate nursing on their role in the process.
The biggest challenge was obtaining organizational approval to initiate the infusion using a home care infusion pump that would be unique to our department. This was crucial to ensure a smooth transition for patients and their families, allowing them to receive treatment at home while being fully prepared for what to expect. Additional challenges included managing unexpected events that could arise during home infusions, such as pump malfunctions or tubing disconnections. In addition, securing pharmacy’s support was critical in the development and approval of the processes to ensure the safe handling and administration of Blinatumomab.
From July 20, 2024 to December 31, 2024 CCBD initiated 74 inpatient Blinatumomab infusions and completed 237 bag changes across 2 campuses. We had 32 events that were related to pump, tubing or line issues that were unplanned with most of them occurring during off hours. As patients are newly diagnosed with ALL the process is embedded in our culture and has become standard of care.