Medication Adherence in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Area of Science:

• Hematology
• Pharmacology
• Transplantation Medicine

Background:

• Medication adherence is vital for successful treatment and recovery in hematopoietic stem cell transplantation (HSCT).
• Limited data exist on effective adherence measurement methods and influencing factors in HSCT patients.

Purpose of the Study:

• To assess immunosuppressant medication adherence in patients undergoing allogeneic HSCT.
• To compare different adherence measurement methods and identify predictors of adherence.

Main Methods:

• Prospective longitudinal study of 150 patients undergoing allogeneic HSCT for hematologic malignancies.
• Adherence assessed via pill counts, medication levels, patient logs (dose and timing), and MARS-5 at 30, 100, and 180 days post-HSCT.
• Kappa analysis used to evaluate agreement between measurement methods.

Main Results:

• Adherence rates varied significantly by measurement type: pill counts (52-64%), medication levels (18-24%), patient logs (96-98% dose, 83-84% timing), and MARS-5 (97-98%).
• Minimal agreement observed between objective and patient-reported adherence measures (Kappa range: 0.008-0.12).
• Patient-reported measures indicated high adherence, while objective measures suggested more modest adherence.

Conclusions:

• Discrepancies between objective and patient-reported adherence measures in HSCT patients are significant.
• The complexity of medication regimens likely contributes to adherence measurement variability.
• A comprehensive approach combining both objective and subjective measures is recommended for accurate assessment of medication adherence in HSCT.