Why Open Communication Across Specialties Is Critical to Complex SM Care

Jessica Lewis-Gonzalez, PharmD, BCOP, addresses the practical challenges of managing patients with systemic mastocytosis (SM), a rare and complex disease that requires coordinated care across multiple specialties. She discusses how pharmacists balance mediator-related symptom management, including antihistamines and topical agents, with cytoreductive or targeted therapies aimed at slowing disease progression. Lewis-Gonzalez also reflects on lessons learned from presenting at mastocytosis-focused symposiums and outlines what effective interdisciplinary collaboration looks like when caring for complex patients with SM. Her insights are relevant to pharmacists working in hematology, oncology, and allergy settings who manage or consult on SM care.

Pharmacy Times: How do you approach mediator-related symptom management (eg, anaphylaxis risk, flushing, GI symptoms) alongside cytoreductive or targeted therapy in patients with SM?

Jessica Lewis-Gonzalez, PharmD, BCOP: Yeah, great question. I think for me, it's still gonna be at the forefront of how we manage these patients, so making sure that they know that they need to stay on their therapies to help with those mediator-related symptoms, so their antihistamines, whatever else is helping them. Sometimes it's some topical agents as well, and that we're using the cytoreductive or targeted therapies in addition to that to help keep the disease process from getting worse.

Pharmacy Times: What has your experience presenting at mastocytosis-focused symposiums taught you about gaps in pharmacist education or comfort level with this disease?

Lewis-Gonzalez: I think it forced me to get very comfortable with the disease very quickly. I first spoke on mastocytosis a couple of years ago at a local symposium, and it was a great opportunity to work with a lot of different fields. So we had a lot of different specialties at that conference. And it also was open to patients, which I thought was really neat because then we got to hear firsthand from patients, even outside of the practice that I work in, the impact that some of these therapies have on them. So I think it's really helped me feel more confident in this disease state, but also it really shows that, outside of people who actively practice in patients with SM, there's really still so much that needs to be learned about SM, even for people who do practice with SM. There's a lot of unanswered questions still about the disease.

Pharmacy Times: What does effective interdisciplinary collaboration (allergy, hematology, pharmacy) look like in managing a patient with SM who is considered complex?

Lewis-Gonzalez: Yeah, I feel like almost all of our patients with SM are complex, so it's a great question. I think really open lines of communication are the most important thing, making sure that all specialties know that we play an integral part and that we approach it very collaboratively. So before starting therapies, we're talking to these other providers and saying, "Hey, based on these symptoms, this is what I'm considering starting. How does that align with what you're managing and practicing?" Because we don't wanna get into a situation where we're burning bridges or making anyone feel like their voice or their part in this patient's care doesn't matter as much, because it's all super integral.