Drug-related problems and pharmacist interventions within a pharmaceutical care programme in allogeneic haematopoietic stem cell transplantation

BackgroundPatients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) are exposed to highly complex pharmacotherapy, substantially increasing the risk of drug-related problems (DRPs).ObjectiveTo describe the frequency, causes and status of DRPs, as well as the clinical impact and acceptance of pharmacist interventions, within a structured pharmaceutical care programme in allo-HSCT patients.MethodsProspective, single-centre interventional study conducted within a pharmacist-led pharmaceutical care programme in adults undergoing allo-HSCT over a 12-month period (December 2023-December 2024), with follow-up to day +100 post-transplantation. DRPs and pharmacist interventions were classified using the Pharmaceutical Care Network Europe (PCNE) classification V9.1. Clinical impact was assessed using a validated scale adapted from Hatoum and colleagues.ResultsOf 41 patients assessed, 37 were included. A total of 289 DRPs were identified (median 8 DRPs per patient;IQR 6-11). Most DRPs involved treatment safety (60.2%) and effectiveness (26.6%). DRPs were most frequently identified during the in-hospital phase (45.7%) and post-discharge follow-up (37.0%). The main causes were drug selection (32.0%), dose selection (28.9%) and lack of clinical or analytical monitoring (27.2%). A total of 867 pharmacist interventions were performed; of 780 evaluated, 93.2% were accepted and 93.8% had a significant clinical impact. DRPs were totally (53.3%) or partially (31.1%) resolved.ConclusionA high burden of clinically relevant DRPs was identified in allo-HSCT patients. Pharmacist-led interventions were associated with high acceptance and significant clinical impact, supporting the integration of clinical pharmacists into multidisciplinary transplant teams. Prospective controlled studies are warranted to quantify the clinical benefit of pharmaceutical care in this setting.