6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study.

Abstract

Durable remissions in children with acute lymphoblastic leukemia (ALL) require a 2-year maintenance phase that includes daily oral 6-mercaptopurine (6MP). Adherence to oral 6MP among Asian-American and African-American children with ALL is unknown. We enrolled 298 children with ALL (71 Asian Americans, 68 African Americans, and 159 non-Hispanic whites) receiving oral 6MP for the maintenance phase. Adherence was measured electronically for 39 803 person-days. Adherence declined from 95.0% (month 1) to 91.8% (month 5, P < .0001). Adherence rates were significantly (P < .0001) lower in Asian Americans (90.0% ± 4.9%) and African Americans (87.1% ± 4.4%), as compared with non-Hispanic whites (95.2% ± 1.3%). Race-specific sociodemographic characteristics helped explain poor adherence (African Americans: low maternal education [less than a college degree: 78.9%, vs at least college degree: 94.6%; P < .0001]; Asian Americans: low-income households [<$50 000: 84.5%, vs ≥$50 000: 96.7%; P = .04]; households without mothers as full-time caregivers [85.6%] vs households with mothers as full-time caregivers [97.2%; P = .05]). Adherence rate below 90% was associated with increased relapse risk (hazard ratio, 3.9; P = .01). Using an adherence rate <90% to define nonadherence, 20.5% of the participants were nonadherers. We identify race-specific determinants of adherence, and define a clinically relevant level of adherence needed to minimize relapse risk in a multiracial cohort of children with ALL. This trial was registered at www.clinicaltrials.gov as #NCT00268528.

• Authors: Smita Bhatia, Wendy Landier, Lindsey Hageman, Heeyoung Kim, Yanjun Chen, Kristine R Crews, William E Evans, Bruce Bostrom, Jacqueline Casillas, David S Dickens, Kelly W Maloney, Joseph P Neglia, Yaddanapudi Ravindranath, A Kim Ritchey, F Lennie Wong, Mary V Relling
• Journal: Blood (Blood) Vol. 124 Issue 15 Pg. 2345-53 (Oct 09 2014) ISSN: 1528-0020 [Electronic] United States
• PMID: 24829202 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 by The American Society of Hematology.

Chemical References

• Mercaptopurine

Topics

• Administration, Oral
• Adolescent
• Child
• Child, Preschool
• Cohort Studies
• Demography
• Female
• Humans
• Infant
• Male
• Medication Adherence (ethnology)
• Mercaptopurine (administration & dosage, therapeutic use)
• Multivariate Analysis
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy, ethnology)
• Racial Groups (ethnology)
• Recurrence
• Regression Analysis
• Young Adult