OPTIMIZING TREATMENT, MINIMIZING RISK: THERAPEUTIC DRUG MONITORING IN HEMATOLOGICAL MALIGNANCIES
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Introduction
The therapeutic landscape of hematological malignancies has expanded rapidly, increasing survival but also exposing patients to pharmacokinetic variability and clinically relevant drug–drug interactions. Therapeutic drug monitoring (TDM) offers a pharmacokinetics-informed strategy to individualize dosing, yet its real-world implementation across drug classes and healthcare settings remains insufficiently characterized.
Methods
We conducted an international, cross-sectional online survey (December 2023–February 2024) assessing availability, utilization, and clinical impact of TDM in patients with hematological malignancies. Physicians from multiple specialties reported institutional practices, turnaround times, drug-specific monitoring strategies, and treatment modifications based on TDM results.
Results
A total of 209 physicians from 32 countries participated, predominantly from Europe (92%). TDM was widely accessible (97%), mainly performed onsite (79%), and perceived as beneficial by nearly all respondents (99%). Routine TDM was most frequently used for classical agents (methotrexate, cyclosporin A), antifungals, and antibiotics, but substantial interest was reported for targeted therapies, including BCL-2 inhibitors, BCR-ABL tyrosine kinase inhibitors, FLT3 inhibitors, and Bruton tyrosine kinase inhibitors. Treatment was modified based on TDM results by 71% of respondents, with faster turnaround times strongly associated with clinical action. Limited assay availability, delayed reporting, and insufficient clinical evidence were identified as key barriers to broader implementation.
Conclusions
TDM is widely available and actively influences clinical decision-making in the management of hematological malignancies. While firmly established for classical agents and anti-infectives, clinicians express growing interest in extending TDM to targeted therapies. Optimizing turnaround times, expanding assay availability, and integrating pharmacokinetics-informed dosing into clinical trials may further strengthen the role of TDM within precision medicine approaches in hematology.
Downloads
Citations
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
