Blinatumomab

[MAF] Blinatumomab (Blincyto) Infusion 35 mcg

1. Treatment of B-precursor acute lymphoblastic leukaemia in first or subsequent complete remission with minimal residual disease (MRD) for:
   – up to a maximum of one cycle for induction in a lifetime;
   – and up to three additional cycles for consolidation in a lifetime.
   
   Complete remission is defined as a patient who:
   a) has 5% or less bone marrow blasts; and
   b) has no evidence of disease; and
   c) has a full recovery of peripheral blood counts with platelet count of more than 100,000 per microlitre; and
   d) has absolute neutrophil count of more than 1,000 per microlitre.

2. Treatment of relapsed or refractory B-precursor acute lymphoblastic leukaemia for:
   – up to a maximum of two cycles for induction in a lifetime; and
   – up to three additional cycles for consolidation in a lifetime in patients who achieve a complete response after induction.
   
   Patients with Philadelphia chromosome positive disease must have previously received a tyrosine kinase inhibitor before receiving blinatumomab.
   Patients must not have received blinatumomab previously for the treatment of minimal residual disease (MRD)-positive B-ALL OR patients must have had a relapse-free period of at least six months following completion of treatment with blinatumomab for MRD.
   
   Complete response is defined as a patient who:
   – has 5% or less bone marrow blasts; and
   – has no evidence of disease; and
   – has platelet count of more than 50,000 per microlitre; and
   – has absolute neutrophil count of more than 500 per microlitre.

[MSHL] Blinatumomab Powder For Infusion 35 mcg vial

1. Treatment of B-precursor acute lymphoblastic leukaemia in first or subsequent complete remission with minimal residual disease (MRD) for:
   – up to a maximum of one cycle for induction in a lifetime;
   – and up to three additional cycles for consolidation in a lifetime.
   
   Complete remission is defined as a patient who:
   a. has 5% or less bone marrow blasts; and
   b. has no evidence of disease; and
   c. has a full recovery of peripheral blood counts with platelet count of more than 100,000 per microlitre; and
   d. absolute neutrophil count of more than 1,000 per microlitre

2. Treatment of relapsed or refractory B-precursor acute lymphoblastic leukaemia (r/r B-ALL) for:
   – up to a maximum of two cycles for induction in a lifetime; and
   – up to three additional cycles for consolidation in a lifetime in patients who achieve a complete response after induction.
   
   Patients with Philadelphia chromosome positive disease must have previously received a tyrosine kinase inhibitor before receiving blinatumomab.
   Patients must not have received blinatumomab previously for the treatment of minimal residual disease (MRD)-positive B-ALL OR patients must have had a relapse-free period of at least six months following completion of treatment with blinatumomab for MRD.
   
   Complete response is defined as a patient who:
   – has 5% or less bone marrow blasts; and
   – has no evidence of disease; and
   – has platelet count of more than 50,000 per microlitre; and
   – has absolute neutrophil count of more than 500 per microlitre.

Legend

This section shows the following:

• Subsidy Scheme and Clinical Indication (where applicable) of drugs listed in the MOH List of Subsidised Drugs

• Subsidised brands of vaccines recommended in the National Immunisation Schedules listed in the MOH Subsidised Vaccine List

• Cancer Drug and Clinical Indication listed in the MediShield Life Cancer Drug List

As this website is updated monthly, please refer to MOH List of Subsidised Drugs, MOH Subsidised Vaccine List or MediShield Life Cancer Drug List for the most updated information.

13/09/2024 Review of cancer drugs for acute lymphoblastic leukaemia

The Ministry of Health’s Drug Advisory Committee has recommended:

• Blinatumomab powder for infusion 35 mcg/vial;

• Dasatinib 20 mg, 50 mg and 70 mg tablets;

• Ponatinib 15 mg tablets; and

• Inotuzumab ozogamicin 1 mg powder for concentrate for solution for infusion

for treating acute lymphoblastic leukaemia (ALL) in line with specific clinical criteria.

Subsidy status

[R] Blinatumomab powder for infusion 35 mcg/vial is recommended for inclusion on the Medication Assistance Fund (MAF) with effect from 4 January 2022^a for treating patients with B-precursor ALL in first or subsequent complete remission with minimal residual disease (MRD) for:

• up to a maximum of one cycle for induction in a lifetime; and

• up to three additional cycles for consolidation in a lifetime.

[R] Complete remission is defined as a patient who:
a) has 5% or less bone marrow blasts; and
b) has no evidence of disease; and
c) has a full recovery of peripheral blood counts with platelet count of more than 100,000 per microlitre; and
d) has absolute neutrophil count of more than 1,000 per microlitre.

[R] Dasatinib 20 mg, 50 mg and 70 mg tablets are recommended for inclusion on MAF with effect from 1 September 2022 for treating patients with:

• newly diagnosed Philadelphia chromosome positive ALL (Ph+ALL) in combination with chemotherapy; or

• Ph+ALL with resistance or intolerance to prior treatment with imatinib.

[R] Ponatinib 15 mg tablet is recommended for inclusion on MAF with effect from 1 September 2022 for treating patients:

• with Ph+ALL who are resistant to dasatinib;

• who are intolerant to dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate; or

• who have the T315I mutation.

[R] Inotuzumab ozogamicin 1 mg powder for concentrate for solution for infusion is recommended for inclusion on MAF with effect from 1 April 2022 for treating patients with relapsed or refractory CD22 positive B-precursor ALL for:

• up to a maximum of three cycles for induction in a lifetime; and

• up to three additional cycles for consolidation in a lifetime for patients who achieve a complete response after induction.

[R] Patients with Philadelphia chromosome positive disease must have previously received a tyrosine kinase inhibitor before receiving inotuzumab.

[R] Complete response is defined as a patient who:
a) has 5% or less bone marrow blasts; and
b) has no evidence of disease; and
c) has platelet count of more than 50,000 per microlitre; and
d) has absolute neutrophil count of more than 500 per microlitre.

Clinical indications, subsidy class and MediShield Life claim limits for all drugs included in the evaluation are provided in the Annex.

^arevised clinical indication with effect from 1 Nov 2024.

04/01/2022 Blinatumomab for treating relapsed or refractory B-precursor acute lymphoblastic leukaemia

The Ministry of Health’s Drug Advisory Committee has recommended:

• Blinatumomab powder for infusion 35 mcg/vial for treating relapsed or refractory B-precursor acute lymphoblastic leukaemia (r/r B-ALL) for:

• up to a maximum of two cycles for induction in a lifetime; and

• up to three additional cycles for consolidation in a lifetime in patients who achieve a complete response after induction.

Patients with Philadelphia chromosome positive disease must have previously received a tyrosine kinase inhibitor before receiving blinatumomab.

Patients must not have received blinatumomab previously for the treatment of minimal residual disease (MRD)-positive B-ALL OR patients must have had a relapse-free period of at least six months following completion of treatment with blinatumomab for MRD.

Complete response is defined as a patient who:

• has 5% or less bone marrow blasts; and

• has no evidence of disease; and

• has platelet count of more than 50,000 per microlitre; and

• has absolute neutrophil count of more than 500 per microlitre.

Subsidy status

[R] Blinatumomab powder for infusion 35mcg/vial is recommended for inclusion on the Medication Assistance Fund (MAF) for the abovementioned indication.

Legend

This section displays recommendation from the MOH Drug Advisory Committee for subsidy and appropriate use of the drug as extracted from the Agency for Care Effectiveness (ACE) Drug Guidances. As this website is updated monthly, please refer to the ACE website for the most updated information.

Note:

General availability information reflected is based on the Public Healthcare Institutions’ (PHI) formulary on what is commonly used for treating their patient population and may or may not be available for patients not under the care of that institution. It does not reflect the PHI’s actual inventory availability and is subjected to change. Please consult the Public Hospitals or Polyclinics for details on availability and supply restrictions/considerations. General availability is not tied to any brand unless otherwise stated.

Users are to consult the respective PHIs for actual inventory availability and supply restrictions/consideration