title: Physician compliance and relapse rates of acute lymphoblastic leukemia in children.
abstract: We studied the prescription patterns of maintenance therapy for children with acute lymphoblastic leukemia and their association with duration of complete remission. Both 6-mercaptopurine and methotrexate (MTX) were prescribed in doses significantly lower than those recommended (75 mg/m2 daily 6-mercaptopurine; 20 mg/m2 weekly MTX) during maintenance therapy. Of 212 evaluated patients, patients who had relapses (n = 101) received significantly less MTX compared with patients who did not have relapses (n = 111) during the first 2 years of maintenance therapy. In the group of standard-risk patients who received the same induction therapy (n = 92), 11 of 17 who received less than 50% of the recommended MTX dose (64%) and 28 of 75 who received greater than 50% of the dose (37%) had relapses (P less than 0.05). The two groups had comparable periods of interruption of MTX therapy. Further analysis revealed that the lower maintenance dose stemmed from a continuous low prescribed dose and not from more frequent interruption of therapy in relapse. Physicians' inability or failure to adhere to the recommended protocol was associated with a higher relapse rate of acute lymphoblastic leukemia. Improved physicians' compliance may improve the prognosis of the disease.
authors.affiliation: Division of Hematology-Oncology, Hospital for Sick Children, Toronto, Ontario.
authors.forename: M
authors.initials: M
authors.lastname: Peeters
authors.forename: G
authors.initials: G
authors.lastname: Koren
authors.forename: D
authors.initials: D
authors.lastname: Jakubovicz
authors.forename: A
authors.initials: A
authors.lastname: Zipursky
mesh_terms: D000284:Administration, Oral; D001932:Brain Neoplasms / Q000517:prevention & control; D002648:Child; D006801:Humans; D007278:Injections, Spinal; D007945:Leukemia, Lymphoid / Q000188:drug therapy* / Q000517:prevention & control; D015122:Mercaptopurine / Q000008:administration & dosage*; D008727:Methotrexate / Q000008:administration & dosage*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D011879:Radiotherapy Dosage; D012074:Remission Induction
chemical_list: D015122:Mercaptopurine; D008727:Methotrexate