Random serum methotrexate determinations for assessing compliance with maintenance therapy for childhood acute lymphoblastic leukemia.
The cure rate for acute lymphoblastic leukemia (ALL) may exceed 85%. Up to three years of maintenance therapy with weekly methotrexate (MTX) and daily 6-mercaptopurine is required. Compliance with maintenance is essential to eliminate the residual leukemic clone. We determined the compliance status of children with ALL treated at a University Hospital. The study had three phases: a direct structured interview, the search for lack of compliance documented in the clinical files, and measurement of serum MTX levels, in three random occasions, using a polarized fluorescent immunoassay. In 5 of 49 (10%) interviews, at least an episode of non-compliance was reported. In the clinical file, 8 of 49 (16.3%) patients referred skipping maintenance drugs. In 14 of 49 (28.6%) children, MTX was not present in serum in at least one measurement. Face-to-face interviews and clinical file notes were unreliable sources for monitoring compliance. Random determination of serum MTX levels should be given consideration for monitoring long-term compliance with maintenance therapy in children with ALL.
Department of Hematology, Dr. José Eleuterio González University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, México. carjaime@hotmail.com
José Carlos
JC
Jaime-Pérez
David
D
Gómez-Almaguer
Adriana
A
Sandoval-González
Adrián
A
Chapa-Rodríguez
Oscar
O
Gonzàlez-Llano
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000097:blood / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007118:Immunoassay; D007407:Interviews as Topic; D008297:Male; D008727:Methotrexate / Q000097:blood / Q000627:therapeutic use*; D008991:Monitoring, Physiologic / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods; D010349:Patient Compliance / Q000706:statistics & numerical data*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy*
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate