{
  "abstract": "Background: Blinatumomab is a bispecific anti-CD19/CD3 antibody used in the treatment of refractory B-cell acute lymphoblastic leukemia (ALL) with measurable residual disease. Although it has a favorable safety profile, neurotoxicity and cytokine release syndrome are the most common adverse events. Drug-induced liver injury (DILI) and acute pancreatitis are rare but potentially serious events, and their early recognition is essential for proper management and patient safety. Case report: A 31-year-old female patient with Philadelphia-negative B-cell ALL diagnosed in March 2020. She received augmented HyperCVAD chemotherapy followed by allogeneic bone marrow transplantation in December 2020. In September 2023, she presented with extramedullary relapse and underwent salvage therapy. In June 2024, she was admitted for biliary prosthesis replacement via ERCP and oncological treatment, at which time blinatumomab was initiated as a bridge therapy for a potential CAR-T therapy or a second transplant. On June 17, 2024, AST (20 U/L), ALT (51 U/L), AMI (34 U/L), and LIP (26 U/L) were within the normal range. The infusion was initiated on June 18, 2024 (9 mcg/day), and after eight hours, elevated transaminases were observed: AST (280 U/L) and ALT (341 U/L), indicating grade 3 hepatotoxicity, associated with severe headache. The medication was discontinued, resulting in clinical and laboratory improvement. After six days, it was reintroduced without recurrence of hepatotoxicity. On July 2, 2024, following an increase in the dose to 28 mcg/day, the patient developed a significant elevation in AMI (894 U/L) and LIP (3111 U/L), along with abdominal pain consistent with acute pancreatitis, leading to another suspension of blinatumomab. After pancreatic enzymes normalized within three days, treatment was started again and completed without further events. Discussion: The temporal association between blinatumomab use and the hepatic and pancreatic abnormalities, combined with the exclusion of infectious, autoimmune, metabolic, and obstructive causes, as well as any medical procedures performed, supported the diagnosis of drug-induced liver injury (DILI) and acute pancreatitis induced by the medication. Causality was confirmed through validation of the suspected Adverse Drug Reaction by a pharmacovigilance center, corroborated by the RUCAM, Naranjo, WHO, and European Union algorithms. Although the mechanisms remain uncertain, it is believed that immune activation and cytokine release play a significant role. This case highlights the importance of laboratory monitoring, early discontinuation of the drug, and careful reintroduction after resolution of the events, allowing for the continuation of onco-hematological treatment. Conclusion: DILI and acute pancreatitis associated with blinatumomab are rare but potentially serious events. Early recognition, systematic investigation, and multidisciplinary management enabled clinical and laboratory recovery, as well as the safe resumption of therapy. This report reinforces the role of active pharmacovigilance and intensive monitoring, especially at the start of infusion and after dose escalation, contributing to greater safety in the use of immunobiological agents in patients with ALL.",
  "abstract_shown": true,
  "affiliations": [
    "Hospital Universitário Professor Edgard Santos (HUPES-UFBA), Salvador, BA, Brazil"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Elder Trindade DAMASCENO"
    },
    {
      "affs": [
        0
      ],
      "name": "Geisa Queiroz ALMEIDA"
    },
    {
      "affs": [
        0
      ],
      "name": "Gláucia Noblat SANTOS"
    },
    {
      "affs": [
        0
      ],
      "name": "Leonardo Augusto Toledo KISTER"
    },
    {
      "affs": [
        0
      ],
      "name": "Luana Sávia Santos SILVA"
    },
    {
      "affs": [
        0
      ],
      "name": "Paloma Peixoto Santos FIÚZA"
    },
    {
      "affs": [
        0
      ],
      "name": "Ivana Moura Leal COELHO"
    },
    {
      "affs": [
        0
      ],
      "name": "Maisa Rafaele Silva SILVA"
    },
    {
      "affs": [
        0
      ],
      "name": "Mônica Lopes Sampaio SILVA"
    },
    {
      "affs": [
        0
      ],
      "name": "Rafaela Leal Machado BORGES"
    },
    {
      "affs": [
        0
      ],
      "name": "Alessandro Moura ALMEIDA"
    },
    {
      "affs": [
        0
      ],
      "name": "Marianna Batista Vieira LIMA"
    },
    {
      "affs": [
        0
      ],
      "name": "Cristiane Almeida Requião PINNA"
    },
    {
      "affs": [
        0
      ],
      "name": "Daniela Dourado DUTRA"
    },
    {
      "affs": [
        0
      ],
      "name": "Edvan Queiroz CRUSOE"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1443rr1r4ee9z.bib",
  "cited_by": 0,
  "doi": "10.1016/j.htct.2026.107691",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2531137926014380",
  "id": "1443rr1r4ee9z",
  "issns": [
    "2531-1379",
    "2531-1387"
  ],
  "landing_url": "https://doi.org/10.1016/j.htct.2026.107691",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2739|Acute Lymphoblastic Leukemia research"
    ]
  ],
  "openalex": "W7223144705",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/1443rr1r4ee9z.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:22Z",
      "native_id": "0b4e5110db2f4719a0f4b30d88b8ca37",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.htct.2026.107691"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Acute Lymphoblastic Leukemia research",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "SEVERE HEPATOTOXICITY AND ACUTE PANCREATITIS ASSOCIATED WITH THE USE OF BLINATUMOMAB IN A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA",
  "title_text": "SEVERE HEPATOTOXICITY AND ACUTE PANCREATITIS ASSOCIATED WITH THE USE OF BLINATUMOMAB IN A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:18Z",
  "url": "https://research.draconitic.com/paper/1443rr1r4ee9z",
  "venue": "Hematology, Transfusion and Cell Therapy",
  "versions": []
}