Dr Tinajero on the Role of Pharmacists in Treatment Planning and Management in CML

“Pharmacists are uniquely equipped to not only counsel and educate patients on the importance of adherence to therapy, but [we can] also help identify and mitigate toxicities associated with these agents.”

Jose Tinajero, PharmD, BCOP, a bone marrow transplant and hematology clinical pharmacist at City of Hope, outlined the essential role of the oncology pharmacist in the management of chronic myeloid leukemia (CML).

As treatment has evolved from first-generation TKIs to multiple second- and third-generation options and, more recently, allosteric inhibition, pharmacists have become increasingly integral to treatment planning, toxicity management, and patient adherence, he said.

Tinajero emphasized that pharmacists are uniquely positioned to counsel and educate patients on the importance of strict adherence to TKIs, which remains a critical determinant of response durability and long-term disease control. Given that CML therapy is almost exclusively oral and requires consistent, long-term daily administration, pharmacists play a central role in reinforcing adherence expectations, addressing barriers such as complex dosing requirements, and ensuring patients understand drug-food and drug-drug interactions. These interactions are particularly relevant in CML, where agents such as imatinib (Gleevec), dasatinib (Sprycel), nilotinib (Tasigna), ponatinib (Iclusig), and asciminib (Scemblix) each carry unique administration parameters and metabolic pathways.

Beyond education, pharmacists help identify, monitor, and mitigate treatment-related toxicities. As Tinajero noted, adverse effects—including cytopenias, hepatotoxicity, cardiovascular risk, and gastrointestinal intolerance—may significantly impact quality of life and adherence. Pharmacists assess toxicity patterns early, intervene with supportive care measures, and collaborate with advanced practice providers and the broader oncology team to adjust therapy when necessary. When toxicities become difficult to manage, pharmacists contribute to decisions regarding dose modifications or switching to alternative TKIs with more favorable toxicity profiles.

Pharmacists also support therapeutic sequencing. With multiple TKIs now approved, treatment selection requires careful evaluation of disease risk category, patient comorbidities (particularly cardiovascular), prior intolerance or resistance patterns, and concomitant medications. Pharmacists assist in evaluating these variables, ensuring that each TKI selection aligns with clinical guidelines and patient-specific considerations.

Tinajero highlighted that ongoing communication between pharmacists, clinicians, and patients is essential to maintaining adherence, addressing evolving toxicity or interaction concerns, and optimizing long-term outcomes. As CML care continues to advance, the pharmacist’s role in education, toxicity mitigation, therapeutic sequencing, and collaborative care remains central to effective disease management.