October 2026 in Hematology: 5 Updates Shaping the Profession

October 2026’s hematology coverage examined how treatment decisions evolve across the patient journey. Pirtobrutinib entered first-line care for selected patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL), while multiple myeloma coverage explored when treatment should begin and how long maintenance should continue. Research also highlighted opportunities to reduce medication-related harm and help patients obtain prescribed oral therapies.^1-5

These 5 updates from Pharmacy Times connect clinical developments with decisions that pharmacists encounter in everyday practice.

Pirtobrutinib Moves Into First-Line CLL/SLL Treatment

The FDA’s October 2, 2026, approval of pirtobrutinib (Jaypirca; Eli Lilly and Company) for previously untreated CLL/SLL expanded the noncovalent Bruton tyrosine kinase inhibitor’s role to adults with no known 17p deletion.¹

The decision followed the phase 3 BRUIN CLL-313 trial (NCT05023980), which randomly assigned 282 patients to pirtobrutinib or bendamustine plus rituximab. Median progression-free survival was not reached with pirtobrutinib versus 33.5 months with chemoimmunotherapy (hazard ratio, 0.20; 95% CI, 0.11–0.37). Estimated progression-free survival at 24 months was 93.4% and 70.7%, respectively.¹

The expansion brings additional patients into continuous oral treatment, making medication reconciliation and longitudinal monitoring particularly relevant. Pharmacists should assess interactions and bleeding risk while monitoring for infections, cytopenias, and hepatotoxicity. The trial’s comparator also matters: these findings do not establish superiority over other contemporary targeted first-line regimens.¹

ENDURANCE Questions Indefinite Myeloma Maintenance

Coverage of the ENDURANCE trial examined whether indefinite lenalidomide maintenance improves survival compared with a fixed 2-year course in standard-risk newly diagnosed multiple myeloma without upfront autologous stem-cell transplantation.²

Among 516 randomized patients, 7-year overall survival was 68.6% with indefinite treatment and 69.0% with fixed-duration treatment. The difference was not statistically significant. Grade 3 or higher nonhematologic adverse events occurred in 48.2% and 31.5% of patients, respectively.²

The absence of a significant survival difference does not establish equivalence, and the findings should not be extrapolated to high-risk disease or posttransplant maintenance. For pharmacists, the study supports reassessing tolerability throughout treatment and bringing cumulative toxicity into discussions about continued therapy.²

Early Linvoseltamab Treatment Raises Benefit-Risk Questions

An interview about linvoseltamab in high-risk smoldering myeloma explored a different timing question: whether intervention before symptomatic disease offers enough benefit to justify treatment-related risks.³

Paula Rodríguez-Otero, MD, PhD, a LINKER-SMM1 investigator and hematologist at Clínica Universidad de Navarra, discussed patient selection and the infection burden associated with the BCMA-directed bispecific antibody. The phase 2 study is investigating linvoseltamab in a setting where patients are otherwise asymptomatic.³

Linvoseltamab remains investigational for smoldering myeloma. The discussion underscores why promising antimyeloma activity must be considered alongside treatment burden. For pharmacy teams, understanding the population being studied and the potential consequences of infection is essential when interpreting emerging early-intervention strategies.³

Dedicated Pharmacist Care Reduces Adverse Drug Reactions

A randomized trial provided evidence supporting dedicated pharmacist involvement in outpatient hematologic cancer care. Among 182 patients, at least 1 adverse drug reaction occurred in 23.1% receiving pharmacist-led care compared with 47.3% receiving standard care.⁴

Moderate or severe reactions occurred in 5.5% and 19.8%, respectively. The intervention included medication assessments and patient counseling, with treatment recommendations communicated to physicians. Approximately 95% of the pharmacist’s 588 recommendations were implemented.⁴

The single-center design and short follow-up limit generalizability. Nevertheless, the findings support integrating pharmacists into treatment management and recognizing medication review as a clinical intervention that can prevent harm.⁴

Insurance Approval Does Not Guarantee Oral Treatment Access

Research on oral blood cancer medication access showed why authorization approval should not end pharmacy follow-up. Among 12,134 patients, only 54.5% with Medicare and 45.5% with commercial insurance had both approval and a filled prescription within 90 days.⁵

Approved prescriptions remained unfilled for 30.5% of the entire Medicare cohort and 17.4% of the commercial cohort. Higher out-of-pocket costs were associated with lower fill rates, highlighting affordability barriers after coverage was secured.⁵

The analysis used 2022 claims, predating current Medicare Part D benefit changes. Its practical message remains relevant: pharmacists should follow prescriptions through dispensing, assess affordability directly, and coordinate financial navigation when patients cannot obtain treatment.⁵

REFERENCES

1. Halpern L. FDA approves pirtobrutinib for previously untreated CLL/SLL. Pharmacy Times. October 2, 2026. Accessed October 30, 2026. https://www.pharmacytimes.com/view/fda-approves-pirtobrutinib-for-previously-untreated-cll-sll

2. Kariyawasam-Chavez R. Does multiple myeloma maintenance therapy need to continue indefinitely? Pharmacy Times. October 21, 2026. Accessed October 30, 2026. https://www.pharmacytimes.com/view/does-multiple-myeloma-maintenance-therapy-need-to-continue-indefinitely-

3. Kariyawasam-Chavez R, Rodríguez-Otero P. Could linvoseltamab change when we treat high-risk smoldering myeloma? Pharmacy Times. October 5, 2026. Accessed October 30, 2026. https://www.pharmacytimes.com/view/could-linvoseltamab-change-when-we-treat-high-risk-smoldering-myeloma-

4. Kariyawasam-Chavez R. Oncology pharmacists reduce adverse drug reactions in hematologic cancer care. Pharmacy Times. October 21, 2026. Accessed October 30, 2026. https://www.pharmacytimes.com/view/oncology-pharmacists-reduce-adverse-drug-reactions-in-hematologic-cancer-care

5. Kariyawasam-Chavez R. Insurance approval leaves gaps in oral blood cancer treatment access. Pharmacy Times.October 29, 2026. Accessed October 30, 2026. https://www.pharmacytimes.com/view/insurance-approval-leaves-gaps-in-oral-blood-cancer-treatment-access