Treatment adherence in chronic lymphocytic leukemia and chronic myeloid leukemia: an integrative review

To synthesize the scientific evidence on oral treatment adherence in patients with chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML), and to identify effective nursing interventions.

An integrative review of the literature was conducted. A systematic search was performed in PubMed (including MEDLINE), Scopus, CINAHL, and Google Scholar for studies published between January 2015 and December 2024, including early online publications indexed in 2025. MeSH/DeCS terms related to medication adherence, chronic leukemias, tyrosine kinase inhibitors, and nursing care were used. Studies conducted in adult patients with CML or CLL receiving oral tyrosine kinase inhibitors (TKIs) that evaluated nursing interventions and measured adherence using objective methods or validated scales were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklists.

A total of 805 records was identified, of which 9 studies met the inclusion criteria. Adherence to TKIs in CML ranged from 56% to 97%. Multicomponent nursing-led interventions demonstrated significant improvements in adherence (mean difference of 25.2 percentage points; p = 0.002) and major molecular response (22.6 percentage-point difference; p = 0.010). The most effective components included personalized face-to-face education, structured telephone follow-up, proactive management of adverse events, and objective adherence monitoring. The level of evidence was classified as Grade A for multicomponent interventions and Grade B for unimodal interventions.

There is strong evidence (Grade A) that structured, multicomponent nursing interventions significantly improve therapeutic adherence and clinical outcomes in patients with CML treated with TKIs. The implementation of structured adherence programs is recommended as a standard of care in hematology units.