Beyond the Prescriber: Integrating the Multidisciplinary Team Into CML Management

In the continued discussion of multidisciplinary care for CML, the team emphasizes the importance of early and comprehensive molecular and cytogenetic testing in newly diagnosed patients. Bone marrow biopsy is often the first step, allowing for conventional cytogenetics to assess chromosomal abnormalities and blast percentage. If a biopsy has already been performed elsewhere, confirmatory tests like peripheral blood fluorescence in situ hybridization and polymerase chain reaction are still ordered. Identifying the specific BCR::ABL1 transcript variant (most commonly p210) is crucial for long-term monitoring. Although next-generation sequencing isn’t routinely required in chronic phase CML, it may be used selectively based on individual risk factors.

Pharmacists play an essential role in the initial treatment strategy by helping tailor therapy to the patient’s medical profile. They assess medication adverse effects, drug-drug interactions, and comorbidities to match patients with the most appropriate tyrosine kinase inhibitor (TKI). Particular attention is paid to medications such as proton pump inhibitors or antidepressants that can cause interactions or QT prolongation. The goal is to ensure patients can adhere to therapy and avoid overlapping toxicities that might lead to early treatment discontinuation.

Nurse practitioners and physician assistants further support the multidisciplinary approach by coordinating baseline testing, managing adverse effects, and ensuring continuity of care. They work closely with physicians to align treatment with patient comorbidities, clinical guidelines, and personal goals. These advanced practice providers also educate patients on adherence, adverse effect management, and when to seek help. Because a significant portion of patients discontinue TKI therapy within the first year, this consistent follow-up and patient empowerment are critical to maintaining successful long-term outcomes in CML care.