A systematic review found that evidence about adherence to tyrosine kinase inhibitors (TKIs) among patients with chronic myeloid leukemia (CML) has largely overlooked the patient perspective. These findings were published in the American Journal of Clinical Oncology.

Researchers from the University of South Carolina searched publication databases for studies on adherence to TKI treatment of CML. As nonadherence remains a significant problem and is associated with increased mortality, the reviewers wanted to assess best practices for maintaining adherence.

A total of 14 articles were included in this review. Most studies were of retrospective cohort design and 8 used claim records, which did not allow for assessing potential barriers to treatment adherence.

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Of the studies that compared specific drugs, one found greater adherence as well as a lower healthcare utilization cost with nilotinib (P =.009); two others found greater adherence to dasatinib (P =.036). Another study compared imatinib to either dasatinib or nilotinib and found no difference in adherence.

Programs that used pharmacist monitoring (P =.0135), oncology pharmacist monitoring (P <.0046), or pharmacist-led adherence diaries (P <.0001) resulted in superior treatment adherence compared with other interventions. In 1 study, participation in a Happy Club demonstrated improved treatment adherence (P =.001) among patients receiving imatinib doses of 400 mg or higher.

A limitation in this review was that the studies used different measures to determine adherence, including healthcare costs, drug comparisons, and healthcare team interactions. However, the studies reviewed trended toward a general lack of a patient-perspective component.

Despite TKIs having been used for nearly 20 years, the review authors conclude that few studies have been conducted on reasons for patient nonadherence and strategies for addressing those reasons. Additional randomized trials are needed to assess biobehavioral interventions that could be most effective at increasing TKI compliance for CML treatment.


Heiney SP, Sorrell M, Sheng J, et al. Interventions to improve adherence to tyrosine kinase inhibitors in chronic myeloid leukemia: a systematic review. Am J Clin Oncol. 2021;44(6):291-298. doi:10.1097/COC.0000000000000818