A Novel Side Effect of Blutnimab in B Cell Lymphoma Management - A Captivating Case Report

Abstract Introduction: Blutinumab is a commonly used immunotherapeutic agent for acute lymphoblastic leukemia (ALL) that targets B cell lymphoma cells. However, limited knowledge exists regarding its potential neurological side effects. We present a case of a 43-year-old female patient with ALL who developed white matter lesions and cognitive impairment during Blutinumab therapy. Methods: The patient underwent modified BFM inductions followed by post bone marrow aspiration (BMA) inductions and consolidations. Initial brain CT scan showed no abnormalities, but subsequent imaging three months later revealed symmetrical white matter lesions, confirmed by brain MRI. Extensive investigations, including avascular risk factor assessment, inflammatory and infectious screenings, metabolic evaluations, and cerebrospinal fluid (CSF) analysis, yielded unremarkable results. Results: Given the absence of alternative etiologies and the temporal association between Blutinumab therapy initiation and the development of neurological symptoms and imaging abnormalities, we hypothesize a potential link between Blutinumab and the observed white matter lesions and cognitive impairment. Neurological side effects, including headache and cognitive impairment, have been reported in approximately 10% to 30% of patients receiving Blutinumab. Conclusion: This case emphasizes the need for increased awareness of potential neurological side effects associated with Blutinumab therapy. Further investigation and monitoring are necessary to establish a definitive causal relationship and optimize patient care. Healthcare professionals should be vigilant in recognizing and managing such adverse events to ensure favorable treatment outcomes.