With the High Burden of GVHD Treatment, Pharmacists Play an Important Role in Supporting Education, Medication Adherence

Although hematopoietic stem cell transplantation (HSCT) provides benefits for patients who have received blood transfusions, it can also increase the risk of infection. According to the CDC, a stem cell transplant destroys and rebuilds a person’s immune system, which can cause it to weaken.¹ Chronic graft-vs-host disease (GVHD) is a potential resulting infection that is also a major cause of late morbidity and mortality after allogeneic HSCT.² Although there have been advances in the treatment of GVHD, there is still a need for a better understanding of this disease.

In a Pharmacy Time In clinical forums, the panel discussed the integration of pharmacists into treatment care for patients with chronic GVHD, which has been shown to improve patients’ quality of life and reduce the financial and treatment burden of the disease. During the panel, participants explained how chronic GVHD can impact patients, especially with the number of medications patients have to take. “Of course it’s very difficult to have that medication burden,” Daniel Przybylski, PharmD, BCOP, clinical pharmacist in hematology/oncology at Northwestern Medicine in Chicago, Illinois, told the forum. “Looks like they’re taking medicine all day.”

Przybylski added that pharmacists are in a unique position to help ease the burden of medication for patients. He added that pharmacists can also view patient treatment profiles and dispense drugs that help alleviate financial toxicity, which can support medication adherence and improve quality of life.

Krystal Preston, PharmD, BCPS, senior clinical oncology pharmacist at CVS Health and clinical pharmacist at University of Chicago Medicine, adds that patients who take multiple medications may not know what each drug is for, so pharmacists are there to educate them. about the importance of treatment regimens for chronic GVHD.

“They are not leaving [to get that information] from [physician]; they will get that information from us. We have to find creative ways to make sure it sticks [adherence to their medication] important,” said Preston.

Additionally, Kaily Kurzweil, PharmD, BCOP, a clinical pharmacist, bone marrow transplant, and cellular therapy at Northwestern Memorial Hospital, explains that doctors may also continue to add medications to treat the various symptoms of GVHD. However, these drugs are not always effective in treating these symptoms. According to Kurzweil, sometimes there isn’t a great answer for managing some of the more severe symptoms of GVHD. Furthermore, Kurzweil notes that other quality-of-life burdens for patients with GVHD include excessive medical appointments for patients to schedule and attend.

“We did a lot of referrals for us [patients with] GVHD. If they have vaginal GVHD, we refer them [obstetrics and gynecology]. If they have ocular GVHD, we refer them to our optometrists. So they don’t just see us, [but] they also have a commitment to add specialists,” Kurzweil said.

Preston explained that in one of his previous positions, the facility would arrange car service for patients to relieve some of the transportation burden that may be caused by the high number of medical appointments.

Furthermore, Preston notes the role of pharmacists in the education of physicians and other health care professionals is very important. Connor Roth, PharmD, BCOP, pharmaceutical hematology/oncology specialist at the Franciscan Alliance, Inc explains that sometimes GVHD can present with vague or unclear symptoms that all healthcare professionals don’t recognize, so education about GVHD symptoms may be necessary to improve diagnosis. .

“I wish we had better advocates for resources [to train other health care professionals on GVHD symptoms],” says Kurzweil. “Education is very important for other providers who notice these symptoms first on admission.”

Reference

1. Stem cell transplant patient and fungal infection. Fungal disease. Centers for Disease Control and Prevention. Updated May 28, 2020. Accessed July 12, 2023. https://www.cdc.gov/fungal/infections/stem-cell.html
2. HamiltonBK. An update on chronic graft-versus-host disease. Am Soc Hematol Hematology Education Program. 2021;2021(1):648-654. doi:10.1182/hematology.2021000301