Clinical Scorecard: 49th Annual Conference of the European Society for Blood and Marrow Transplantation: Oral Session by the Pharmacist Committee (O173-O175)

At a Glance

Key Highlights

• Pharmacist review of medications via mHealth platform improved medication validation and patient communication in allo-SCT recipients.
• Busulfan TDM using either single-day or multi-day dosing regimens was evaluated to optimize therapeutic exposure in pediatric HCT patients.
• mHealth tools facilitated interdisciplinary care, symptom reporting, and non-urgent consultation resolution in allo-SCT management.

Guideline-Based Recommendations

Diagnosis

• Use mHealth platforms to monitor symptoms, adverse events, and medication adherence in allo-SCT patients.
• Perform therapeutic drug monitoring of busulfan to achieve target cumulative AUC (80–100 mg*h/L) in pediatric HCT conditioning.

Management

• Pharmacists should review and validate patient-entered medications to ensure safety and appropriateness.
• Adjust busulfan dosing based on TDM results from day 1 or days 1 + 2 to optimize exposure and reduce toxicity.
• Utilize interdisciplinary teams including clinical pharmacists to provide personalized pharmaceutical care.

Monitoring & Follow-up

• Monitor medication adherence through patient self-reporting and pharmacist follow-up via mHealth communication.
• Conduct blood sampling on day 4 of busulfan administration to evaluate cumulative exposure.
• Use validated pharmacokinetic models to estimate busulfan AUC and guide dose adjustments.

Risks

• Incorrect dosing or unsafe medications identified and rejected by pharmacists to prevent adverse events.
• Potential under- or over-exposure to busulfan if TDM is not performed or dosing adjustments are inadequate.

Patient & Prescribing Data

28 allo-SCT recipients (adults) and 141 pediatric patients undergoing allogeneic HCT

Mean of 9.5 drugs per patient reviewed; 70.7% of drugs activated after pharmacist validation; busulfan dosing adjusted based on TDM to achieve target exposure.

Clinical Best Practices

• Integrate clinical pharmacists into the allo-SCT care team to review medications and communicate with patients via mHealth tools.
• Employ mHealth platforms to enhance patient engagement, symptom tracking, and medication adherence monitoring.
• Use therapeutic drug monitoring with validated pharmacokinetic models to guide busulfan dosing in pediatric HCT conditioning regimens.
• Provide patient education and accessible information libraries within mHealth applications to support self-management.

References

• European Society for Blood and Marrow Transplantation Annual Meeting