Chronic lymphocytic leukemia (CLL) is a hematologic malignancy that has seen significant advances in care over the last 5 years with the approval of oral agents such as ibrutinib and venetoclax for the treatment of this disease. As such, there has been a substantial shift away from the traditional chemotherapy infusions which have allowed patients greater autonomy with oral cancer therapies. This paradigm shift poses new challenges for the medical team, including drug–drug interactions, adherence counseling, and financial toxicity. Pharmacists are uniquely trained and equipped to help to manage the changing landscape of CLL care. From identifying common medications which may impair ibrutinib clearance to ensuring patients are on the appropriate anti-infective prophylaxis while receiving obinutuzumab, pharmacists can play a vital role in ensuring the highest quality of patient care. Furthermore, additional credentialing of clinical pharmacists in select states allows for independent visits with the pharmacists, allowing for greater involvement, particularly for initiation of venetoclax and management of ibrutinib-induced toxicities. Pharmacists are essential to both expanding and enhancing the care of patients with CLL and should be leveraged to improve patient outcomes whenever possible.

OBJECTIVE: This study aimed to evaluate the use of levofloxacin for the prevention of bacterial infections in pediatric patients with acute myeloid leukemia or those undergoing hematopoietic stem cell transplantation. METHODS: This study was a single-center, retrospective review designed to assess the frequency of bacteremia with levofloxacin prophylaxis compared with historical controls that used other, clinician-directed antibacterial prophylaxis. The primary outcome of the study was microbiologically documented bacteremia. Secondary outcomes included febrile neutropenia, clinically documented infection, duration of neutropenia, treatment antibiotic exposure days, Clostridioides difficile infection, and infection-related mortality. RESULTS: Of the 60 patients included, 24 patients with 32 hospital admissions received levofloxacin and 36 patients with 48 hospital admissions received clinician-directed prophylaxis. There was no difference found in the frequency of bacteremia between levofloxacin and clinician-directed prophylaxis (15.6% vs 10.4%, p = 0.49). There was no difference in the incidence of febrile neutropenia, clinically documented infection, treatment antibiotic exposure days, or 30-day infection-related mortality between the 2 groups. The levofloxacin group had a longer mean duration of neutropenia compared with clinician-directed prophylaxis (26.8 days vs 16.4 days, p = 0.01). CONCLUSIONS: There was no difference in bacteremia between levofloxacin prophylaxis and clinician-directed prophylaxis in pediatric patients with acute myeloid leukemia or those undergoing hematopoietic stem cell transplantation. Levofloxacin prophylaxis is an appropriate alternative for the prevention of serious bacterial infections in this patient population, although further studies are needed to confirm these results.

Introduction: Cancer and Leukemia Group B (CALGB) 10403 is a pediatric-inspired treatment protocol for adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) patients. During Course V maintenance, patients receive mercaptopurine (6MP) and oral methotrexate (MTX), which require frequent laboratory monitoring and dose adjustments. The purpose of this study was to characterize the impact of pharmacist intervention on the safe implementation of Course V. Methods: This single-center, retrospective chart review included AYA patients with B- or T-cell ALL who initiated treatment with CALGB 10403 at UNCMC between April 2014 and April 2024. The primary endpoint was the rate of pharmacist-driven 6MP and MTX holds per protocol during Course V. The key secondary endpoint was the rate of pharmacist-driven 6MP and MTX dose adjustments during Course V. Results: All 18 patients required chemotherapy dose adjustments. Pharmacists led 6MP and MTX dose interruptions in 25 of 35 (71.4%) instances and dose modifications in 85 of the 140 (60.7%) instances. With the addition of a second pharmacist in the leukemia clinic, the monthly rate of pharmacist-led dose holds and modifications for 6MP and MTX increased by over four-fold. Conclusion: Pharmacists played a significant role in the safe administration of 6MP and MTX, particularly with the addition of a second clinic pharmacist. This study demonstrates the value of pharmacist involvement in optimizing patient safety during treatment of ALL.