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

Academic Article

Abstract

  • © 2014 by The American Society of Hematology. Durable remissions in children with acute lymphoblastic leukemia (ALL) require a 2-year maintenancephase that includesdailyoral 6-mercaptopurine (6MP).Adherenceto oral6MP 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.
  • Published In

  • Blood  Journal
  • Digital Object Identifier (doi)

    Author List

  • Bhatia S; Landier W; Hageman L; Kim H; Chen Y; Crews KR; Evans WE; Bostrom B; Casillas J; Dickens DS
  • Start Page

  • 2345
  • End Page

  • 2353
  • Volume

  • 124
  • Issue

  • 15