6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study.
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.
Department of Population Sciences, City of Hope, Duarte, CA;
Smita
S
Bhatia
Department of Population Sciences, City of Hope, Duarte, CA;
Wendy
W
Landier
Department of Population Sciences, City of Hope, Duarte, CA;
Lindsey
L
Hageman
Department of Population Sciences, City of Hope, Duarte, CA;
Heeyoung
H
Kim
Department of Population Sciences, City of Hope, Duarte, CA;
Yanjun
Y
Chen
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN;
Kristine R
KR
Crews
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN;
William E
WE
Evans
Department of Hematology/Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN;
Bruce
B
Bostrom
Department of Pediatrics and Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA;
Jacqueline
J
Casillas
Division of Pediatric Hematology/Oncology, Helen DeVos Children's Hospital at Spectrum Health/Spectrum Health at Butterworth Campus, Grand Rapids, MI;
David S
DS
Dickens
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO;
Kelly W
KW
Maloney
Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Minnesota Medical School, Minneapolis, MN;
Joseph P
JP
Neglia
Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, MI; and.
Yaddanapudi
Y
Ravindranath
Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.
A Kim
AK
Ritchey
Department of Population Sciences, City of Hope, Duarte, CA;
F Lennie
FL
Wong
Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN;
Mary V
MV
Relling
D000284:Administration, Oral; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D015122:Mercaptopurine / Q000008:administration & dosage / Q000627:therapeutic use*; D015999:Multivariate Analysis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000208:ethnology*; D044469:Racial Groups / Q000208:ethnology*; D012008:Recurrence; D012044:Regression Analysis; D055815:Young Adult
D015122:Mercaptopurine