Modern chemotherapy for pediatric acute B-lymphoblastic leukemia (B-ALL), including a maintenance phase on the backbone of oral antimetabolite administration, has resulted in a generally excellent prognosis for newly diagnosed disease. However, therapy-related toxicities may preclude a patient’s ability to safely receive traditional chemotherapy. We report the case of a child with B-ALL unable to tolerate oral antimetabolite therapy due to recurring necrotizing pancreatitis secondary to asparaginase. She received a modified maintenance therapy with blinatumomab, a CD3- and CD19-directed bispecific T-cell engager antibody, which was well tolerated and allowed for resolution of her pancreatitis while maintaining a durable remission.