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A Multi-disciplinary Approach to Managing Chronic Myelogenous Leukemia Patients on Oral Anticancer Therapy at a Large Academic Medical Center

  • Chronic Myeloid Leukemias (MJ Mauro and G Saglio, Section Editors)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Since the discovery of imatinib, an oral breakpoint cluster region—Abelson murine leukemia tyrosine kinase inhibitor, chronic myelogenous leukemia transformed from a hematologic malignancy primarily treated with intravenous chemotherapy to a disease almost solely managed with oral agents. While certainly there are benefits to taking a medication at home, this change in treatment modality also came with unique challenges, including patient adherence, medication acquisition and cost, and toxicity management.

Recent Findings

Pharmacists are uniquely equipped to assist with educating patients, safe prescribing, and access to medications. Several studies have described the benefits of an integrated oral anticancer medication management program in the ambulatory setting, including improvements in patient adherence, side effect management, patient comprehension, and drug-interaction detection. Pharmacists are also specially trained to assist with medication dose adjustments, relative lab monitoring, and co-pay assistance.

Summary

Here, we describe the multidisciplinary workflows established to manage oral therapies in chronic myelogenous leukemia patients in a malignant hematology clinic at a large academic medical center. By using the unique talents of the clinic pharmacist, clinic nurse, and specialty retail pharmacy group, patients can be triaged to help ensure the correct skill set is used to optimally care for patients. An acuity-based monitoring structure can improve the ability to reach and safely monitor a large volume of patients.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. O’Brien SG, Fo Guilhot, Larson RA, Gathmann I, Baccarani M, Cervantes F, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348(11):994–1004. https://doi.org/10.1056/NEJMoa022457.

    Article  CAS  PubMed  Google Scholar 

  2. Ganesan P, Sagar TG, Dubashi B, Rajendranath R, Kannan K, Cyriac S, et al. Nonadherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia. Am J Hematol. 2011;86(6):471–4. https://doi.org/10.1002/ajh.22019.

    Article  PubMed  Google Scholar 

  3. Marin D, Bazeos A, Mahon FX, Eliasson L, Milojkovic D, Bua M, et al. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol. 2010;28(14):2381–8. https://doi.org/10.1200/JCO.2009.26.3087.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Noens L, van Lierde MA, De Bock R, Verhoef G, Zachee P, Berneman Z, et al. Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood. 2009;113(22):5401–11. https://doi.org/10.1182/blood-2008-12-196543.

    Article  CAS  PubMed  Google Scholar 

  5. McCue DA, Lohr LK, Pick AM. Improving adherence to oral cancer therapy in clinical practice. Pharmacotherapy. 2014;34(5):481–94. https://doi.org/10.1002/phar.1399.

    Article  PubMed  Google Scholar 

  6. Lam MS, Cheung N. Impact of oncology pharmacist-managed oral anticancer therapy in patients with chronic myelogenous leukemia. J Oncol Pharm Pract. 2016;22(6):741–8. https://doi.org/10.1177/1078155215608523.

    Article  PubMed  Google Scholar 

  7. ••Muluneh B, Schneider M, Faso A, Amerine L, Daniels R, Crisp B, et al. Improved adherence rates and clinical outcomes of an integrated, closed-loop, pharmacist-led oral chemotherapy management program. J Oncol Pract. 2018;14(6):e324–34. https://doi.org/10.1200/JOP.17.00039Outlines the major impact a pharmacist-led oral chemotherapy management program can have on improving patient knowledge, adherence, and possibly CML response rates.

    Article  PubMed  Google Scholar 

  8. ••Morgan KP, Muluneh B, Deal AM, Amerine LB. Impact of an integrated oral chemotherapy program on patient adherence. J Oncol Pharm Pract. 2018;24(5):332–6. https://doi.org/10.1177/1078155217703792Reveals how an integrated, pharmacist-led oral chemotherapy program , in collaboration with their internal specialty pharmacy colleagues, had high medication possession ratios for patients that filled at the institution’s specialty pharmacy.

    Article  PubMed  Google Scholar 

  9. Etienne G, Guilhot J, Rea D, Rigal-Huguet F, Nicolini F, Charbonnier A, et al. Long-term follow-up of the French Stop Imatinib (STIM1) Study in patients with chronic myeloid leukemia. J Clin Oncol. 2017;35(3):298–305. https://doi.org/10.1200/JCO.2016.68.2914.

    Article  PubMed  Google Scholar 

  10. Atallah E, Schiffer CA, Radich JP, Weinfurt KP, Zhang MJ, Pinilla-Ibarz J, et al. Assessment of outcomes after stopping tyrosine kinase inhibitors among patients with chronic myeloid leukemia: a nonrandomized clinical trial. JAMA Oncol. 2020. https://doi.org/10.1001/jamaoncol.2020.5774.

    Article  PubMed  Google Scholar 

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Correspondence to Angela Canadeo.

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Angela Canadeo, Mary Fournogerakis, and Felicia Zook declare no potential conflicts of interest.

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This article contains no studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Chronic Myeloid Leukemias

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Canadeo, A., Fournogerakis, M. & Zook, F. A Multi-disciplinary Approach to Managing Chronic Myelogenous Leukemia Patients on Oral Anticancer Therapy at a Large Academic Medical Center. Curr Hematol Malig Rep 16, 509–516 (2021). https://doi.org/10.1007/s11899-021-00659-9

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  • DOI: https://doi.org/10.1007/s11899-021-00659-9

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