Blinatumomab Utilization in Pediatric B-Cell Acute Lymphoblastic Leukemia: Experience From the Mountain West

Blinatumomab is a bispecific T-cell engager approved for the treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL). Outpatient home infusion reduces hospitalization burden and optimizes resource utilization, but is logistically challenging.

Our institution developed a multidisciplinary outpatient blinatumomab protocol. The workflow included early prior authorization, home healthcare (HH) partnerships, and standardized procedures for outpatient management. Clinical and logistical data were prospectively collected from August 2024 to August 2025.

Since initiation, 50 patients aged 1-23 years have received blinatumomab. Patients resided within five states across the Intermountain West, with distances to the treating hospital ranging from 4.8 to 640 miles (mean 109 miles). Thirty patients (60%) lived within 50 miles of the treating institution, four (8%) lived 50-100 miles away, and 16 (32%) resided more than 100 miles away. All patients were able to receive blinatumomab outpatient, with 96% of patients able to receive services locally for the majority of the infusion period. Ninety-eight percent of patients used HH for outpatient drug delivery and/or nursing care. Our workflow standardized agency responsibilities, bag change frequency, and emergency contact protocols. This model limited inpatient stays to 24-48 h for most patients, expanded access across a large geographic area, and decreased travel burden.

Outpatient blinatumomab administration is feasible, safe, and resource-efficient when supported by a structured care coordination framework. Partnerships with HH providers, proactive insurance authorization, and standardized troubleshooting protocols are critical for success. This model has reduced costs, preserved hospital resources, and improved quality of life.