Pharmacist-Patient Interaction and Busulfan TDM in Allogeneic Stem Cell Transplantation

Overview

Two studies presented at the 49th EBMT Annual Conference highlight the role of mHealth platforms in enhancing pharmacist-patient communication for allo-SCT recipients and compare single versus multiday busulfan therapeutic drug monitoring (TDM) in pediatric allogeneic hematopoietic cell transplantation. The mHealth tool facilitated medication review and adherence monitoring, while busulfan TDM regimens were evaluated for target exposure attainment.

Background

Allogeneic stem cell transplantation (allo-SCT) patients often face complex medication regimens requiring careful management to optimize outcomes. Mobile health (mHealth) platforms can support personalized pharmaceutical care by enabling symptom tracking and communication. Busulfan is a key conditioning agent in pediatric hematopoietic cell transplantation, with exposure levels closely linked to clinical outcomes, necessitating therapeutic drug monitoring (TDM) to achieve optimal dosing.

Data Highlights

Key Findings

• Pharmacists reviewed 297 medications entered by 22 allo-SCT patients via an mHealth platform, validating 70.7% for patient activation.
• Pharmacists sent 118 messages and received 65 patient messages, enhancing communication and pharmaceutical care.
• Only 4 patients self-registered medication adherence on the platform, though 27 completed adherence questionnaires externally.
• Pharmacist interventions included rejecting 3 medications due to dosing errors or safety concerns.
• The busulfan TDM study included 141 pediatric patients receiving 4-day intravenous busulfan conditioning.
• The study compared single-day versus multiday TDM regimens to assess attainment of target busulfan exposure (AUC 80–100 mg*h/L).

Clinical Implications

Integration of pharmacists into mHealth platforms can improve medication management and patient engagement in allo-SCT care, facilitating early identification of drug-related issues. For pediatric patients undergoing busulfan conditioning, optimizing TDM regimens is critical to achieving therapeutic targets and improving transplant outcomes. These approaches support personalized, interdisciplinary care in hematopoietic transplantation.

Conclusion

The mHealth platform effectively enhanced pharmacist-patient interactions and medication oversight in allo-SCT recipients, while ongoing evaluation of busulfan TDM strategies aims to refine dosing precision in pediatric transplantation. Together, these studies underscore the value of technology and pharmacological expertise in improving transplant patient management.

References

1. Moreno-Martinez et al. 2023 -- Analysis of the Patient-Pharmacist Interaction Through an mHealth Platform in Allo-SCT (MYMEDULA Study)
2. Bognàr et al. 2023 -- Busulfan Target Exposure Attainment in Pediatric Allogeneic HCT: Single vs Multiday TDM