Food Restrictions May Affect Adherence in Chronic Myeloid Leukemia

Key Clinical Summary

• More than half of patients with chronic myeloid leukemia (CML) taking tyrosine kinase inhibitors (TKIs) with food restrictions reported challenges adhering to dosing instructions.
• One-third of patients reported taking medication without following fasting requirements at least once during the previous month, and nearly 30% reported skipping a dose.
• More than half of patients indicated they would consider switching to an alternative therapy without food restrictions if recommended by their health care provider.

Food restrictions associated with certain CML therapies may negatively affect treatment adherence and quality of life, according to findings from a patient survey published in Blood. 

The study evaluated experiences among patients receiving TKIs that require fasting before and after dosing, including nilotinib and asciminib. Researchers sought to better understand how food-related administration requirements influence daily routines, medication adherence, and treatment preferences.

Survey Examined Real-World Experiences

Investigators surveyed 152 adults with self-reported CML through MyLeukemiaTeam, an online patient community, between April and May 2025.

The analysis focused on 119 patients, including 55 individuals receiving TKIs with food restrictions and 64 patients receiving TKIs without such requirements.

The median patient age was 67 years, 63% were female, and most participants were White and non-Hispanic. Medicare was the primary insurance source for 61% of respondents.

Patients were receiving a variety of CML therapies, including nilotinib, asciminib, dasatinib, imatinib, and bosutinib.

Adherence Challenges Were More Common With Food Restrictions

Although patients in both groups reported similar optimism regarding disease management and future health, those taking TKIs with food restrictions reported significantly greater logistical challenges.

Among patients receiving nilotinib or asciminib, 76% reported adjusting meal timing to accommodate medication requirements, compared with 34% of patients receiving therapies without food restrictions.

Similarly, 69% reported needing to plan daily activities around medication schedules, compared with 44% of patients in the non-food restriction group.

Nearly half of patients receiving therapies with food restrictions reported difficulty taking their medication exactly as prescribed, compared with 20% of patients receiving therapies without such requirements.

Specific challenges included waking up early or staying awake late to meet fasting requirements, difficulty coordinating meals, disruptions during holidays or social events, and avoiding food in social situations.

One participant described “constantly watching the clock” to determine when eating and medication administration were permitted.

Missed Doses and Improper Administration Reported

Food restrictions appeared to affect medication adherence directly.

During the previous 30 days, 33% of patients reported taking their medication without maintaining an empty stomach at least once, while 29% reported skipping at least 1 dose.

Although most patients recalled discussing food restrictions with their health care provider before initiating therapy, fewer than two-thirds reported understanding why the restrictions were necessary. Only 3 respondents specifically recalled being informed about risks such as QT interval prolongation, cardiac toxicity, or death.

Interest in More Flexible Treatment Options

Researchers also evaluated patients’ interest in therapies without food restrictions.

When presented with the concept of an alternative TKI that did not require fasting, 56% of patients said they would likely switch if offered the option by their health care provider.

Among patients who were uncertain or unlikely to switch, 71% indicated that further discussion with their clinician could influence their decision.

Implications for Managed Care

The findings highlight the potential impact of treatment administration requirements on adherence, patient satisfaction, and long-term disease management.

For managed care stakeholders, the results suggest that medication convenience and administration burden may represent important considerations when evaluating treatment selection, adherence programs, and patient support strategies.

Conclusion

Among patients with CML, food restrictions associated with certain TKIs were linked to greater treatment burden and adherence challenges. Investigators suggest that clinicians should routinely discuss administration requirements, potential risks, and available alternatives to help patients maintain optimal treatment adherence and quality of life.

Reference

Glassner HL, Douer D, Lee E, Cronin DH. Impact of treatments with food restrictions on adherence and quality of life aspects among CML patients. Blood. 2025;146(suppl 1):2833. doi:10.1182/blood-2025-2833