Blinatumomab [BLI3]

The treatment of patients in first complete haematological complete remission and with minimal residual disease post 1st line induction chemotherapy in B-precursor acute lymphoblastic leukaemia in ADULT patients where all the following criteria are met:

1. This application has been made by and the first cycle of systemic anti-cancer therapy with blinatumomab will be prescribed by a consultant specialist specifically trained and accredited in the use of systemic anti-cancer therapy.
2. The patient is an adult* *note there is a separate Bluteq form to be used for blinatumomab in this minimal residual disease indication in children.
3. The patient has CD19 positive acute lymphoblastic leukaemia (ALL). Please indicate below whether the patient has Philadelphia negative or positive ALL:

• Philadelphia negative ALL (use is on-label) or
• Philadelphia positive ALL (use is off-label). By ticking this box for use in Philadelphia positive ALL, I confirm that my hospital Trust policy regarding unlicensed treatments is being followed as blinatumomab is not licensed in Philadelphia positive ALL.

4. The patient has been previously treated with intensive 1st line combination chemotherapy as initial induction treatment.
5. The patient is in complete haematological remission of ALL.
6. The patient’s bone marrow has been shown to have a minimal residual disease level of ≥ 0.01% (≥10-4) leukaemic cells confirmed in a validated assay.

Note

Note: a patient who has minimal residual disease (MRD) negativity defined as being less than 0.01% is potentially eligible for blinatumomab as part of consolidation therapy via form BLI5.

7. Blinatumomab will only be requested by and administered in either bone marrow transplant centres or in major haematological centres that regularly treat patients with MRD positive ALL and who have close and regular ALL multi- disciplinary team meetings and links with bone marrow transplant centres.
8. The patient has an ECOG performance status of 0-2.
9. A maximum of 4 cycles of blinatumomab will be administered to this patient.
10. Blinatumomab will be used as monotherapy.

Note

Note: intrathecal chemotherapy and appropriate tyrosine kinase inhibitors may be continued as planned during any blinatumomab cycles.

11. No planned treatment breaks of more than SIX weeks beyond the expected cycle length are allowed (to allow any toxicity of current therapy to settle or intercurrent comorbidities to improve).* *Requests for continuation of treatment after unplanned treatment breaks over this duration should be made via the treatment break approval process
12. Blinatumomab will otherwise be used as set out in its Summary of Product Characteristics (SPC).

NHS funded From: 22 October 2019

Additional information

Form version: -

CDF Managed Access: NA

NICE Technology Appraisal: TA589 (24 July 2019)

Current Form Version

Note

The data on this page was produced using version 1.377 of the CDF list, downloaded from NHS England’s website on 18 November 2025 at 09:00.

If NHS England has published a new version of the CDF List but this site has not yet accessed that, this form may be out of date. Additionally, if any update has occurred without NHS England noting it as a change, this page will be out of date.

Older Form Versions

There are previous versions of this form. These may not all be available on this site.

• BLI3_prior_to_cdf_1.352
• BLI3_prior_to_cdf_1.361
• BLI3_prior_to_cdf_1.377