Nursing Considerations for Administration and Management of Blinatumomab

Background: Pediatric acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Although cure rates exceed 85%, current chemotherapy regimens have high toxicity rates, and the prognosis for patients who relapse remains poor. Immunotherapy has allowed for a reduction in adverse effects and toxicities, and created more treatment options for children with relapsed or refractory disease. Blinatumomab, a bispecific T-cell engager antibody that targets CD19 and CD3, has successfully treated pediatric patients with ALL, yet poses unique challenges with administration and management. The role of the pediatric oncology nurse is essential in ensuring blinatumomab therapy is safe and efficacious. As a result of the complicated administration process and specific management, different institutions have implemented specific protocols, but no guideline exists specifically for nurses. Nurses are at the forefront of care and require nursing-based guidelines when delivering blinatumomab therapy. Objective: To provide a clinical overview for nurses administering and managing blinatumomab in the pediatric oncology population. Methods: A literature review was performed using CINAHL and PubMed. Findings: Two-hundred fifteen articles were searched using the terms blinatumomab and pediatric acute lymphoblastic leukemia. A secondary search was performed, adding in terms nurse and nursing management. Eighteen articles were identified as relevant to this review and are synthesized in this article. A standardized approach specific to nursing is necessary to care for pediatric patients receiving blinatumomab to ensure patient safety and optimize maximum efficacy of the immunotherapy. Keywords: Blinatumomab, pediatric acute lymphoblastic leukemia, nursing.