Characterizing pharmacist impact in maintenance therapy for adolescent and young adults with acute lymphoblastic leukemia treated with CALGB 10403 protocol

IntroductionCancer and Leukemia Group B (CALGB) 10403 is a pediatric-inspired treatment protocol for adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) patients. During Course V maintenance, patients receive mercaptopurine (6MP) and oral methotrexate (MTX), which require frequent laboratory monitoring and dose adjustments. The purpose of this study was to characterize the impact of pharmacist intervention on the safe implementation of Course V.MethodsThis single-center, retrospective chart review included AYA patients with B- or T-cell ALL who initiated treatment with CALGB 10403 at UNCMC between April 2014 and April 2024. The primary endpoint was the rate of pharmacist-driven 6MP and MTX holds per protocol during Course V. The key secondary endpoint was the rate of pharmacist-driven 6MP and MTX dose adjustments during Course V.ResultsAll 18 patients required chemotherapy dose adjustments. Pharmacists led 6MP and MTX dose interruptions in 25 of 35 (71.4%) instances and dose modifications in 85 of the 140 (60.7%) instances. With the addition of a second pharmacist in the leukemia clinic, the monthly rate of pharmacist-led dose holds and modifications for 6MP and MTX increased by over four-fold.ConclusionPharmacists played a significant role in the safe administration of 6MP and MTX, particularly with the addition of a second clinic pharmacist. This study demonstrates the value of pharmacist involvement in optimizing patient safety during treatment of ALL.