Background The Food and Drug Administration has just approved blinatumomab for the treatment of paediatric patients with Philadelphia chromosome negative acute lymphoblastic leukaemia (ALL).¹ Recommended doses in children are 5 μg/m²/day for 1 week followed by 15 μg/m²/day for 3 weeks (continuous infusion for 1 month). A major risk of interactions with other drugs during a putative Y administration appears.

Purpose The objective of this study was to evaluate the visual compatibility of blinatumomab with intravenous drugs commonly administrated in paediatric populations.

Material and methods Usual concentrations of 39 drugs, including anti-infectious, corticoids, sedatives, analgesics and cardiovascular agents, were evaluated. Two blinatumomab concentrations were used, 0.125 μg/mL and 0.375 μg/mL. The effect of mixing the order was ascertained by studying both the tested drugs added to the blinatumomab solution and the blinatumomab solution added to the tested drugs. Visual examination was performed by three different experimenters just after mixing and 60, 150, 240 and 720 min later at room temperature. Compatibility was defined as the absence of any colour change, haze, fibres, particles, gas generation or precipitate.

Results Only caffeine, hydrocortisone and liposomal amphotericin B presented no evidence of visual incompatibility with blinatumomab whatever the tested conditions (mixing order, concentration and time). Different types of visual modifications were observed with others drugs such as particles, flakes, thin needles or haze.

14 tested drugs demonstrated a transient reaction (caspofungine, ceftazidime, ceftriaxone, cotrimoxazole, daptomycin, imipenem–cilastatin, midazolam, naloxone, nefopam, ondansetron, pantoprazole, pediaven, rivotril, vancomycin). 22 tested drugs presented a persistent reaction at least once according to tested concentrations or order of mixing (acetaminophen, albumin, alizapride, ciprofloxacin, cloxacilin, dexamethasone, dexchlorpheniramine, furosemide, rasburicase, dextrose, heparin, hydroxyzine, metronidazole, methylprednisolone, meropenem, morphine, nalbuphine, omeprazole, phloroglucinol, potassium, teicoplanin, tranexamic acid). For seven of these, particles became bigger and bigger, or more numerous between observations time points (alizapride, ciprofloxacin, dexamethasone, heparin, methylprednisolone, omeprazole, teicoplanin).

Conclusion Numerous drugs were identified as visually incompatible with blinatumomab and should not be administered simultaneously through a common intravenous port. For others, further studies need to be done to ensure chemical stability.

References and/or acknowledgements 1. The Asco Post: http://www.ascopost.com/News/43902 Last Updated: 9/7/2016

No conflict of interest