title: Successful reintroduction of blinatumomab in a patient with relapsed/refractory acute lymphoblastic leukemia following grade 4 cytokine release syndrome.
abstract: Relapsed/refractory acute lymphoblastic leukemia poses a clinical challenge due to its poor prognosis and lack of effective treatment. Blinatumomab, a novel immunotherapy, has demonstrated excellent efficacy in relapsed/refractory acute lymphoblastic leukemia; however, life-threatening toxicities such as cytokine release syndrome have been reported in pivotal clinical trials. In this report, we describe the safe reintroduction of blinatumomab in an adult patient with relapsed Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia after experiencing grade 4 blinatumomab-induced cytokine release syndrome using a unique dosing strategy and a very diligent monitoring approach. As blinatumomab often represents a last-line therapeutic option for many patients, such a step-wise dosing approach and diligent monitoring plan may be useful in an attempt to retrial blinatumomab in patients who require reintroduction of therapy.
authors: 1 Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA.
authors: Bernard L
authors: BL
authors: Marini
authors: 2 Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA.
authors: Yihan
authors: Y
authors: Sun
authors: 3 Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
authors: Patrick W
authors: PW
authors: Burke
authors: 1 Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA.
authors: Anthony J
authors: AJ
authors: Perissinotti
mesh_terms: D018033:Antibodies, Bispecific / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D013577:Syndrome
chemical_list: D018033:Antibodies, Bispecific; D000970:Antineoplastic Agents; D016207:Cytokines; C510808:blinatumomab
keywords: Acute lymphoblastic leukemia; blinatumomab; cytokine release syndrome; immunotherapy