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Autoimmune and Inflammatory Disorders Research / CAR-T Cell Therapy Research / Acute Lymphoblastic Leukemia Research · Journal article
JAMA Network Open · September 8, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a descriptive cross-sectional survey characterizing the clinical implementation landscape and outpatient care-delivery challenges for blinatumomab in pediatric B-ALL across US treatment centers. The study documents adoption rates and identifies infrastructure barriers (primarily lack of home care company options and geographic distance) but does not measure clinical outcomes, efficacy, or test solutions to these challenges.
Cross-sectional survey study. Active US Children's Oncology Group member institutions across 44 states treating pediatric B-cell acute lymphoblastic leukemia.. n = 147. 44 US states; 32 Midwest, 30 Northeast, 60 South, 25 West..
134 centers (91.2%) use blinatumomab as standard therapy for standard risk–average B-ALL 144 centers (98.0%) use blinatumomab as standard therapy for standard risk–high B-ALL 140 centers (95.2%) use blinatumomab as standard therapy for high-risk B-ALL
No data on clinical efficacy, safety, or patient outcomes; no measurement of barriers' impact on blinatumomab completion rates or disease outcomes.
Clinicians and health system leaders should recognize that blinatumomab adoption for standard-risk and high-risk pediatric B-ALL is near-universal in surveyed centers, but substantial infrastructure gaps—particularly home care availability and geographic accessibility—persist and may constrain equitable care delivery. These findings should inform planning for supportive services infrastructure and policy to enable wider, more equitable access.
A cross-sectional survey of clinical practice and implementation challenges with no quantitative comparison group, efficacy data, or primary outcome measure; descriptive in nature and identifying barriers rather than testing an intervention or confirming an effect.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and health system leaders should recognize that blinatumomab adoption for standard-risk and high-risk pediatric B-ALL is near-universal in surveyed centers, but substantial infrastructure gaps—particularly home care availability and geographic accessibility—persist and may constrain equitable care delivery. These findings should inform planning for supportive services infrastructure and policy to enable wider, more equitable access.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Importance Blinatumomab, a novel immunotherapy administered as a 28-day continuous infusion, has fundamentally shifted the treatment paradigm for pediatric B-cell acute lymphoblastic leukemia (B-ALL) and is now considered a component of standard therapy for the most common childhood cancer. However, the care delivery challenges in transitioning from an experimental agent on a clinical trial to widespread clinical implementation are unknown. Objective To characterize the clinical landscape of pediatric blinatumomab care-delivery practice and challenges in the US from the perspective of treating centers. Design, Setting, and Participants This survey study was conducted from February to March 2025 among US member institutions of the Children’s Oncology Group (COG) across 44 states. Exposure Institutional characteristics, including participation in the National Cancer Institute Community Oncology Research Program (NCORP), US census region, site-reported annual pediatric ALL patient volume, and prior blinatumomab experience, were assessed. Main Outcomes and Measures Incorporation of blinatumomab as standard therapy by pediatric B-ALL subtype; major outpatient care-delivery challenges defined as 4 or 5 on a 5-point Likert scale by more than 25% of centers. Results Of 195 active US COG member institutions, 147 centers completed the survey and were successfully matched with a unique COG identifier, among which 35 institutions (23.8%) were NCORP participants. There were 32 institutions (21.8%) in Midwest, 30 institutions (20.4%) in Northeast, 60 institutions (40.8%) in South, and 25 institutions (17.0%) in West census regions. Most centers reported using blinatumomab as their institutional standard therapy for National Cancer Institute standard risk–average (134 centers [91.2%]), standard risk–high (144 centers [98.0%]), and high-risk (140 centers [95.2%]) B-ALL. Fewer centers reported using blinatumomab for infant (83 centers [56.5%]) or Philadelphia chromosome–positive (96 centers [65.3%]) B-ALL. The most common major outpatient blinatumomab site care-delivery challenges included lack of home care companies (75 centers [51.0%]), family distance to treating center (41 centers [27.9%]), and insurance coverage for home care companies (37 centers [25.2%]). There were 67 sites (45.6%) that reported having no home care company options for any patients. Conclusions and Relevance In this study, challenges associated with pediatric blinatumomab home care were highly prevalent, with broader implications for health system infrastructure availability. These data highlight a need to plan for clinical implementation strategies alongside the development and testing of novel therapies.
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