BLINATUMOMAB INJ,LYPHL

Clinical Criteria Summary

⇄ This criteria document covers 9 drugs .

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Indication: Relapsed or Refractory CD19-positive B-cell precursor acute lymphoblastic leukemia (ALL)
Pre-medication: Dexamethasone 16 mg IV

Indication: Relapsed or Refractory Multiple Myeloma (BCMA target)
REMS Requirement: Required
Pre-medication: Dexamethasone 20mg PO/IV, Diphenhydramine 25mg PO, Acetaminophen 650mg PO
Additional Supportive Meds: PJP prophylaxis, Antiviral prophylaxis

Indication: Relapsed or Refractory large B-cell lymphoma (CD20 target)
Pre-medication: Dexamethasone 15mg PO/IV, Diphenhydramine 50mg PO/IV, Acetaminophen 650-1000mg PO
Additional Supportive Meds: PJP prophylaxis, Antiviral prophylaxis

Indication: Relapsed or Refractory large B-cell lymphoma (CD20 target)
Pre-medication: Dexamethasone 20mg IV, Diphenhydramine 50mg PO/IV, Acetaminophen 500-1000 mg PO
Additional Supportive Meds: Obinutuzumab day 1, Tumor lysis prophylaxis if at risk, Antiviral prophylaxis, PJP prophylaxis

Indication: Relapsed or Refractory follicular lymphoma (CD20 target)
Pre-medication: Dexamethasone 20mg IV, Diphenhydramine 50-100 mg PO/IV, Acetaminophen 500-1000 mg

Indication: Relapsed or Refractory multiple myeloma (GPRC5D target)
REMS Requirement: Required
Pre-medication: Dexamethasone 16mg PO/IV, Diphenhydramine 50mg PO, Acetaminophen 650-1000mg PO
Additional Supportive Meds: Antiviral prophylaxis
Keratotoxicity Management Criteria: Topical emollients for erythema/rash; saliva replacement therapy (VA National Formulary products include Artificial Saliva Oral Spray, Lozenge, Liquid and Gel) for oral toxicities

Indication: Relapsed or Refractory multiple myeloma (BCMA target)
REMS Requirement: Required
Pre-medication: Dexamethasone 16mg PO/IV, Diphenhydramine 50mg PO/IV, Acetaminophen 650-1000mg PO
Additional Supportive Meds: Antiviral prophylaxis