Pharmacist intervention during CALGB 10403 maintenance in AYA ALL

Results from a single-center chart review, evaluating pharmacist impact during Course V maintenance therapy of the Cancer and Leukemia Group B (CALGB) 10403 protocol in adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL; N = 39), were published in the Journal of Oncology Pharmacy Practice by Andreini et al. Patients were aged ≥18 years and were diagnosed with Philadelphia chromosome-negative (Ph−) or Philadelphia chromosome-like (Ph-like) B‑cell acute lymphoblastic leukemia (B‑ALL), T‑cell ALL, or lymphoblastic lymphoma. The primary endpoint was the rate of pharmacist-driven 6‑mercaptopurine (6MP) and methotrexate (MTX) holds per protocol during Course V of maintenance therapy. 

Key data: Of 39 eligible patients, 18 proceeded to Course V maintenance therapy. All 18 patients who initiated Course V required 6MP or MTX dose holds or modifications, with 216 dose holds/dose modifications recorded. Pharmacists led 6MP and MTX dose holds in 25 of 35 (71.4%) of instances and dose modifications in 85 of 140 (60.7%) instances. Following the addition of a second pharmacist to the leukemia clinic, the monthly rate of pharmacist visits increased by 445%, alongside increases in pharmacist-led dose holds (555%), dose modifications (407%), antimicrobial prophylaxis changes (561%), and supportive care interventions (367%). 

Key learning: Embedded clinical pharmacists played a critical role in the safe administration of 6MP + MTX during CALGB 10403 Course V maintenance therapy in AYA patients with ALL, with expanded pharmacist staffing substantially increasing intervention rates, supporting pharmacist involvement in ALL care.