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Medication adherence among allogeneic hematopoietic stem cell transplant recipients: a pilot single-center study

Bone Marrow Transplantation volume 53, pages 231–233 (2018)Cite this article

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for many malignant or non-malignant hematologic diseases. The preventive post-transplant treatment of these complications after allo-HSCT is based on immunosuppressive and anti-infective drugs and supplements (magnesium, folic acid).1, 2, 3 Therefore, allo-HSCT recipients are discharged from hospital with prescriptions of several drugs to be taken once they return home. Some treatments should be continued for months or even years, especially in the case of graft-versus-host disease after allo-HSCT. Medication adherence was defined by Haynes et al.4 as: ‘the extent to which patients follow the instructions they are given for prescribed treatments’. In 2003, the World Health Organization described medication adherence as the most determining factor in the effectiveness of a treatment (http://www.who.int/chp/knowledge/publications/adherence_report/en/[Internet]. WHO. (cited 21 January 2017)). Medication adherence has been widely evaluated for solid organ transplantation where poor adherence to immunosuppressive drugs was reported among 19–25% of patients5, 6 although in some studies this was as high as 50%.7 In hematology setting, medication adherence has been particularly studied in chronic myeloid leukemia. The ADAGIO study reported a rate of 36% poor adherent patients to tyrosine kinase inhibitors,8 whereas the rate was only 3% in a single-center study.9 However, medication adherence among allo-HSCT recipients has not yet been characterized.10 In 2015, a French report laid the emphasis on this lack of data.11 On account of the large number of medications with significant side effects and anticipated link between high drug adherence and best possible transplant outcome, we conducted a pilot study to assess medication adherence among allo-HSCT recipients.

This observational single-center study was based on a self-administered eight-item Medication Adherence Scale questionnaire completed by previously transplanted patients (at between 60 and 180 days post transplant). The study was conducted in the hematology department of Saint-Antoine Hospital between November 2015 and July 2016. Patients who were able to read and write and were ⩾18 years old were eligible to participate. Each patient was given an information leaflet by a specially trained pharmacist. Due to the observational, non-interventional nature of the study, with anonymized data, requirement for informed consent was waived while patient non-opposition was documented. The study was approved by the Ile-de-France III ethics committee (Comité_de_Protection_des_Personnes / ID RCB: 2015-A01710-49), and was registered with the French national data protection authority (Commission Nationale de l’informatique et des libertés: no. 1902621). As recommended,12 the eight-item Medication Adherence Scale score could be calculated if the respondent answered at least 75% (6 of 8) of the questions. When a reply was missing, the median score of respondents to that item was substituted. Individual item scores were summed up and those patients with a score of 8 were considered high adherents to medication, whereas a poor medication adherence referred to a score under 8. Among poor adherents, medium adherence corresponded to a score of 6–8, while a score of <6 was considered low adherence. Comparisons on categorical variables were performed with Fisher’s exact test and those on continuous variables with Student's test. Statistical significance was reached if p<0.05. Statistical analyzes were performed using R software (Version 0.98.1103— 2009–2014 RStudio, Inc).

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Acknowledgements

We would like to thank the medical and paramedical staff of hematology department: doctors, residents, nurses, caregivers and psychologists for their contribution to the care of the patients’.

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Authors and Affiliations

  1. Service de pharmacie GH-HUEP Site Saint-Antoine, AP-HP, Paris, France

    J Lehrer, C Fernandez & M Antignac

  2. Sorbonne Universités, UPMC Université Paris 06, Paris, France

    E Brissot, F Giannotti & M Mohty

  3. Service d’hématologie clinique et thérapie cellulaire GH-HUEP Site Saint-Antoine, AP-HP, Paris, France

    E Brissot, A Ruggeri, R Dulery, A Vekhoff, G Battipaglia, F Giannotti & M Mohty

  4. France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, F-75013,

    C Fernandez

  5. France Univ. Paris-Sud, Faculté de Pharmacie, Chatenay-Malabry, F-92296, France,

    C Fernandez

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  1. J Lehrer
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Correspondence to J Lehrer.

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Lehrer, J., Brissot, E., Ruggeri, A. et al. Medication adherence among allogeneic hematopoietic stem cell transplant recipients: a pilot single-center study. Bone Marrow Transplant 53, 231–233 (2018). https://doi.org/10.1038/bmt.2017.233

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