Practical Implementation of Oral HMAs in MDS/CMML: Safety, Monitoring, and Coordination

This segment shifts from clinical trial data to the practical realities of implementing oral HMAs in everyday oncology care. Once an oral HMA is prescribed, much of the ongoing work, including monitoring, education, and logistics, falls to nurses, nurse practitioners, pharmacists, and the broader care team.

NP Granato provides a detailed overview of the systems required to safely manage patients on oral HMAs. She highlights cytopenias and infection risk as key challenges, underscoring the importance of setting clear expectations for laboratory monitoring and ensuring patients have reliable access to labs, whether in clinic, at home, or at outside facilities. She explains the need for a rapid triage process for fevers, bleeding, or infection symptoms, which is especially critical in community settings where resources differ from academic centers.

She then describes the logistical complexities unique to community oncology: securing reliable access to blood products despite limited clinic hours, coordinating with external blood centers, and planning growth factor use and prophylactic treatments. NP Granato also outlines the administrative burden, including navigating insurance approvals, prior authorizations, specialty pharmacy coordination, and arranging financial assistance.

Education remains a cornerstone of safe implementation. NP Granato ensures that each patient leaves with structured follow-up plans, lab schedules, medication instructions, and counseling about food restrictions, specifically the requirement to avoid eating two hours before and after dosing, a detail that often surprises patients. She stresses the importance of involving caregivers from the start to support adherence and reinforce instructions.