{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:13:14Z","timestamp":1788880394641,"version":"build-2803163510"},"reference-count":22,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To characterize the clinical landscape of pediatric blinatumomab care-delivery practice and challenges in the US from the perspective of treating centers.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This survey study was conducted from February to March 2025 among US member institutions of the Children\u2019s Oncology Group (COG) across 44 states.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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\u2013average (134 centers [91.2%]), standard risk\u2013high (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\u2013positive (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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.32786","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:00:34Z","timestamp":1788879634000},"page":"e2632786","source":"Crossref","is-referenced-by-count":0,"title":["Blinatumomab Care Delivery for Pediatric B-Cell Acute Lymphoblastic Leukemia"],"prefix":"10.1001","volume":"9","author":[{"given":"Daniel J.","family":"Zheng","sequence":"first","affiliation":[{"name":"University of Pennsylvania, Philadelphia"},{"name":"Division of Oncology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelyn","family":"Oranges","sequence":"additional","affiliation":[{"name":"Division of Oncology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhash","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Children\u2019s Oncology Group, Monrovia, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyun","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa P.","family":"Beauchemin","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah W.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Division of Hematology, Oncology and Bone Marrow Transplant, BC Children\u2019s Hospital, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison Barz","family":"Leahy","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia"},{"name":"Division of Oncology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kira","family":"Bona","sequence":"additional","affiliation":[{"name":"Dana-Farber\/Boston Children\u2019s Cancer and Blood Disorders Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emi H.","family":"Caywood","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania"},{"name":"Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children\u2019s Health, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon M.","family":"Castellino","sequence":"additional","affiliation":[{"name":"Aflac Cancer and Blood Disorders Center, Children\u2019s Healthcare of Atlanta, Winship Cancer Institute, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumit","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, The Hospital for Sick Children, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas S.","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Seattle Children\u2019s Hospital, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Militano","sequence":"additional","affiliation":[{"name":"Children\u2019s Oncology Group, Monrovia, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen E.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"University of Wisconsin-Madison School of Nursing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Newman","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia"},{"name":"Division of Oncology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel E.","family":"Rau","sequence":"additional","affiliation":[{"name":"Ben Towne Center for Childhood Cancer and Blood Disorders Research, Seattle Children\u2019s Hospital, Seattle, Washington"},{"name":"Department of Pediatrics, Fred Hutchinson Cancer Center, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Rheingold","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia"},{"name":"Division of Oncology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna M.","family":"Robles","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Roth","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Teachey","sequence":"additional","affiliation":[{"name":"University of Pennsylvania, Philadelphia"},{"name":"Division of Oncology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Vargas","sequence":"additional","affiliation":[{"name":"Children\u2019s Oncology Group, Monrovia, 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