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J Oncol Pharm Pract. 2018 Sep;24(6):433-452. doi: 10.1177/1078155217710553. Epub 2017 Jun 4.

BCR-ABL1 tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia.

Author information

1
1 Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, USA.
2
2 Pharmacy Department, Hospital of the University of Pennsylvania, USA.
3
3 Department of Pharmacy, University of Louisville Hospital, USA.
4
4 Department of Pharmacy Services, Smilow Cancer Hospital at Yale New Haven, USA.
5
5 Joliet Oncology & Hematology Associates Ltd, USA.

Abstract

The management of chronic myeloid leukemia with BCR-ABL1 tyrosine kinase inhibitors has evolved chronic myeloid leukemia into a chronic, manageable disease. A patient-centered approach is important for the appropriate management of chronic myeloid leukemia and optimization of long-term treatment outcomes. The pharmacist plays a key role in treatment selection, monitoring drug-drug interactions, identification and management of adverse events, and educating patients on adherence. The combination of tyrosine kinase inhibitors with unique safety profiles and individual patients with unique medical histories can make managing treatment difficult. This review will provide up-to-date information regarding tyrosine kinase inhibitor-based treatment of patients with chronic myeloid leukemia. Management strategies for adverse events and considerations for drug-drug interactions will not only vary among patients but also across tyrosine kinase inhibitors. Drug-drug interactions can be mild to severe. In instances where co-administration of concomitant medications cannot be avoided, it is critical to understand how drug levels are impacted and how subsequent dose modifications ensure therapeutic drug levels are maintained. An important component of patient-centered management of chronic myeloid leukemia also includes educating patients on the significance of early and regular monitoring of therapeutic milestones, emphasizing the importance of adhering to treatment in achieving these targets, and appropriately modifying treatment if these clinical goals are not being met. Overall, staying apprised of current research, utilizing the close pharmacist-patient relationship, and having regular interactions with patients, will help achieve successful long-term treatment of chronic myeloid leukemia in the age of BCR-ABL1 tyrosine kinase inhibitors.

KEYWORDS:

BCR-ABL fusion protein; Chronic myeloid leukemia; patient-centered care; protein kinase inhibitors

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