Managing Symptoms, Dose Adjustments, and Telehealth in High-Risk CML

This segment focuses on practical strategies for managing high-risk CML, particularly in patients with proliferative and cytopenic symptoms. The discussion begins with balancing symptomatic management, such as fatigue, early satiety, splenomegaly, anemia, and thrombocytopenia, alongside disease-directed therapy. Dr. Fazal emphasizes the utility of HMAs for achieving meaningful responses, highlighting data from clinical trials supporting their use in CML. A critical point raised is the importance of offering oral treatment options, as some patients may be hesitant to initiate intravenous therapy due to personal circumstances, work commitments, or transportation challenges.

The panel also discusses dose adjustments for cytopenias, explaining that clinicians, often in collaboration with nurse practitioners, can modify treatment schedules based on the patient’s blood counts. This is facilitated by the flexible, short-course nature of oral HMAs, allowing easy adaptation of dosing days and schedules to minimize toxicity while maintaining efficacy.

Telemedicine is presented as a valuable tool to reduce clinic visits, particularly for patients who rely on public transportation or prefer at-home care. Strategies include pre-visit blood draws followed by virtual consultations, ensuring patient monitoring while limiting exposure and travel. For patients with technological challenges, a care partner may assist with video visits, and any significant change in symptoms prompts an immediate in-person evaluation.

Overall, this segment highlights the integration of symptom management, individualized dosing, and telehealth to optimize care, maintain treatment adherence, and enhance quality of life for patients with high-risk CML.