Prevalence and Predictors of Non-Adherence to 6-Mercaptopurine (6MP) in Children with Acute Lymphoblastic Leukemia (ALL) - a Children’s Oncology Group Study.

摘要: Use of contemporary risk-based therapy in children with ALL has resulted five-year survival rates exceeding 80%. Achievement durable remissions requires a maintenance phase composed oral administration antimetabolites (6-mercaptopurine and methotrexate) for approximately two years. Previous studies have shown that low systemic exposure to 6MP adversely affects prognosis, thus emphasizing the critical need therapeutic levels throughout maintenance. However, significant inter-patient variability red cell thioguanine nucleotide (6TGN – major metabolite 6MP) concentrations exists, could part be related failure adhere prescribed therapy. Non-adherence pediatric patients been reported however, small sample sizes varying methods assessment make it difficult understand magnitude this problem. The purpose our study was describe adherence large multi-ethnic cohort ALL. Patients were eligible participate if they diagnosed at age less than 22 years, belonged one four ethnic/racial groups (Asian, African-American, Caucasian, or Hispanic), had completed least 24 weeks We restricted current report Caucasians, where we target accrual. To measure adherence, used Medication Event Management System (MEMS) supplied each patient MEMS TrackCap. This electronic cap allowed collection real-time data by recording date time(s) when bottle opened over 6-month period. downloaded end Patients/parents also self-administered sociodemographic questionnaire. Longitudinal analysis performed using Generalized Estimating Equations. A total 173 Caucasian provided 26,424 person-days observation adherence. median diagnosis 5 years (1 19), participation 6 (range, 2 20); time from 18.8 months, start maintenance, 8.1 months; 67% males. NCI criteria high-risk disease present 42% patients. annual household income between $50K $75K; 79% mothers 72% fathers received education beyond high school. number members (including patient) 4 10). Adherence defined as ratio openings actual doses prescribed, calculated percentage (“percent adherence”). Prescribed entire period reviewed patient, instances withheld prescriber due toxicity illness taken into account purposes calculating mean percent 85% (range 11% 100%). monthly declined significantly (p=0.002). Multivariate identified certain subgroups increased risk lower (Figure): >8 entry (p=0.01); households included other mother, father, (