Implementation of Standardized Clinical Processes for TPMT Testing in a Diverse Multidisciplinary Population: Challenges and Lessons Learned.

Abstract

Although thiopurine S-methyltransferase (TPMT) genotyping to guide thiopurine dosing is common in the pediatric cancer population, limited data exist on TPMT testing implementation in diverse, multidisciplinary settings. We established TPMT testing (genotype and enzyme) with clinical decision support, provider/patient education, and pharmacist consultations in a tertiary medical center and collected data over 3 years. During this time, 834 patients underwent 873 TPMT tests (147 (17%) genotype, 726 (83%) enzyme). TPMT tests were most commonly ordered for gastroenterology, rheumatology, dermatology, and hematology/oncology patients (661 of 834 patients (79.2%); 580 outpatient vs. 293 inpatient; P < 0.0001). Thirty-nine patients had both genotype and enzyme tests (n = 2 discordant results). We observed significant differences between TPMT test use and characteristics in a diverse, multispecialty environment vs. a pediatric cancer setting, which led to unique implementation needs. As pharmacogenetic implementations expand, disseminating lessons learned in diverse, real-world environments will be important to support routine adoption.

• Authors: Kristin W Weitzel, D Max Smith, Amanda R Elsey, Benjamin Q Duong, Benjamin Burkley, Michael Clare-Salzler, Yan Gong, Tara A Higgins, Benjamin Kong, Taimour Langaee, Caitrin W McDonough, Benjamin J Staley, Teresa T Vo, Dyson T Wake, Larisa H Cavallari, Julie A Johnson
• Journal: Clinical and translational science (Clin Transl Sci) Vol. 11 Issue 2 Pg. 175-181 (03 2018) ISSN: 1752-8062 [Electronic] United States
• PMID: 29351371 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

Chemical References

• Antimetabolites, Antineoplastic
• Methyltransferases
• TPMT protein, human

Topics

• Adult
• Age Factors
• Antimetabolites, Antineoplastic (pharmacology, standards, therapeutic use)
• Child
• Child, Preschool
• Decision Support Systems, Clinical
• Enzyme Assays (methods)
• Female
• Genetic Testing (methods)
• Genotype
• Humans
• Interdisciplinary Communication
• Male
• Methyltransferases (genetics, metabolism)
• Middle Aged
• Neoplasms (drug therapy, genetics)
• Patient Education as Topic
• Pharmacists
• Pharmacogenetics (methods)
• Phenotype
• Polymorphism, Genetic
• Practice Guidelines as Topic
• Precision Medicine (methods)
• Tertiary Care Centers