Authors (including presenting author) :
Cheung YMC (1)
Kung SME (1)
Cheung OY (1)
Leung NTK (2)
Lit PS (1)
Kwong YL (1)
Affiliation :
(1) Department of Medicine, Queen Mary Hospital
(2) Department of Pharmacy, Queen Mary Hospital
Introduction :
Blinatumomab is a novel monoclonal antibody for the management of acute lymphoblastic leukemia (ALL). It is superior to conventional chemotherapy in treating relapsed/refractory ALL, and efficacious in patients with measurable residual disease (MRD) or as consolidation treatment. Despite its clinical benefits, one cycle of blinatumomab entails 28 days of continuous intravenous infusion. This is not only inconvenient for patients and their carers due to prolonged hospital stay, but also burdensome to health facilities as it demands significant in-patient resources. With joint efforts from the medical, nursing, and pharmacy teams, a comprehensive home-based infusion programme was pioneered to allow patients to safely continue blinatumomab treatment at home.
Objectives :
(1) To identify and source a suitable set-up for home-based infusion;
(2) To design a comprehensive programme comprising staff training and patient education; and
(3) To prepare infusion protocols and engage suitable patients in home-based infusion service.
Methodology :
Market enquiry was conducted to identify an infusion pump set that met the specific requirements for blinatumomab administration. Drug infusion over a longer duration was preferred, so that patients would not need to return to the hospital daily for change of infusion bag. Thus an infusion bag supporting 7-day use was pursued, which warranted special preparation and reconstitution. With an appropriate ambulatory infusion pump set ready, a webinar was organized to seek first-hand experience from a multi-disciplinary team of prestigious overseas experts. Education materials for staff and patients were drafted; clinical practice guideline as well as treatment protocols were prepared. Multiple sessions were held for staff training before official commencement of home-based infusion service.
Result & Outcome :
Between March 2023 and December 2024, six leukemia patients benefited from this programme with more than ten cycles of blinatumomab administered successfully in the home setting. Not only could in-hospital stay be significantly reduced from four weeks per cycle to one week or less, patient satisfaction and quality of life were also greatly enhanced, as they could spend more time at home with family members. Furthermore, it resulted in a saving of around HK$30,000 (drug costs) and 21 bed-days per patient-cycle. This home-based immunotherapy infusion programme is first-of-its-kind in Hospital Authority and characterized by its holistic, multidisciplinary and patient-first approach. It is effective in optimising patient care and resource utilization, and provides a prototypic standard of prolonged home-based infusion treatment.
