Home-Care Gaps Complicate Outpatient Delivery of Blinatumomab for Pediatric B-ALL

Blinatumomab has rapidly entered standard therapy for pediatric B-cell acute lymphoblastic leukemia, but limited home-care capacity is complicating outpatient delivery across the United States, a Children’s Oncology Group survey found, according to a study published in JAMA Network Open.

The 28-day continuous infusion presents logistical demands beyond prescribing.  Of 149 centers across 44 states that completed the survey in early 2025, 147 matched to unique Children’s Oncology Group site identifiers, forming the analytic cohort on adoption and outpatient delivery challenges. 

More than 90% of centers used blinatumomab as standard therapy for common, standard, and high-risk groups. However, 51.0% identified a lack of home-care companies as a major challenge, 27.9% cited distance from families to treating centers, and 25.2% cited insurance coverage for home care. Sixty-seven centers, or 45.6%, had no home-care company option for any patient.

The survey captured an early implementation period and reflects center, rather than patient or caregiver, perspectives. Practice may have changed since data collection, and the cross-sectional survey was not designed to assess how infrastructure barriers affect clinical outcomes.

The findings show that translating blinatumomab into routine care requires coordinated home infusion, pharmacy, nursing, insurance, and family support. Similar implementation planning may be necessary as other complex pediatric therapies move beyond trials.

Source: Zheng DJ, Oranges K, Ramakrishnan S, et al. Blinatumomab care delivery for pediatric B-cell acute lymphoblastic leukemia.  JAMA Netw Open. 2026;9(9):e2632786. doi:10.1001/jamanetworkopen.2026.32786