TY - JOUR
T1 - 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia
T2 - A Children's Oncology Group study
AU - Bhatia, Smita
AU - Landier, Wendy
AU - Hageman, Lindsey
AU - Kim, Heeyoung
AU - Chen, Yanjun
AU - Crews, Kristine R.
AU - Evans, William E.
AU - Bostrom, Bruce
AU - Casillas, Jacqueline
AU - Dickens, David S.
AU - Maloney, Kelly W.
AU - Neglia, Joseph P.
AU - Ravindranath, Yaddanapudi
AU - Ritchey, A. Kim
AU - Wong, F. Lennie
AU - Relling, Mary V.
N1 - Publisher Copyright:
© 2014 by The American Society of Hematology.
PY - 2014/10/9
Y1 - 2014/10/9
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84907612579&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907612579&partnerID=8YFLogxK
U2 - 10.1182/blood-2014-01-552166
DO - 10.1182/blood-2014-01-552166
M3 - Article
C2 - 24829202
AN - SCOPUS:84907612579
SN - 0006-4971
VL - 124
SP - 2345
EP - 2353
JO - Blood
JF - Blood
IS - 15
ER -
