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

Smita Bhatia; Wendy Landier; Lindsey Hageman; Heeyoung Kim; Yanjun Chen; Kristine R Crews; William E Evans; Bruce Bostrom; Jacqueline Casillas; David S Dickens; Kelly W Maloney; Joseph P Neglia; Yaddanapudi Ravindranath; A Kim Ritchey; F Lennie Wong; Mary V Relling

doi:10.1182/blood-2014-01-552166

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

Journal article

Open access

Peer reviewed

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

Smita Bhatia, Wendy Landier, Lindsey Hageman, Heeyoung Kim, Yanjun Chen, Kristine R Crews, William E Evans, Bruce Bostrom, Jacqueline Casillas, David S Dickens, …

Blood, Vol.124(15), pp.2345-2353

10/09/2014

DOI: 10.1182/blood-2014-01-552166

PMCID: PMC4192748

PMID: 24829202

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Abstract

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.

Multivariate Analysis

Recurrence

Medication Adherence - ethnology

Demography

Administration, Oral

Continental Population Groups - ethnology

Humans

Mercaptopurine - administration & dosage

Child, Preschool

Infant

Male

Young Adult

Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy

Regression Analysis

Mercaptopurine - therapeutic use

Precursor Cell Lymphoblastic Leukemia-Lymphoma - ethnology

Adolescent

Female

Child

Cohort Studies

Details

Title: Subtitle: 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children's Oncology Group study
Creators: Smita Bhatia - Department of Population Sciences, City of Hope, Duarte, CA
Wendy Landier - Department of Population Sciences, City of Hope, Duarte, CA
Lindsey Hageman - Department of Population Sciences, City of Hope, Duarte, CA
Heeyoung Kim - Department of Population Sciences, City of Hope, Duarte, CA
Yanjun Chen - Department of Population Sciences, City of Hope, Duarte, CA
Kristine R Crews - Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
William E Evans - Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
Bruce Bostrom - Department of Hematology/Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
Jacqueline Casillas - Department of Pediatrics and Division of Hematology/Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
David S Dickens - Division of Pediatric Hematology/Oncology, Helen DeVos Children's Hospital at Spectrum Health/Spectrum Health at Butterworth Campus, Grand Rapids, MI
Kelly W Maloney - Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
Joseph P Neglia - Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Minnesota Medical School, Minneapolis, MN
Yaddanapudi Ravindranath - Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, MI; and
A Kim Ritchey - Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
F Lennie Wong - Department of Population Sciences, City of Hope, Duarte, CA
Mary V Relling - Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
Resource Type: Journal article
Publication Details: Blood, Vol.124(15), pp.2345-2353
DOI: 10.1182/blood-2014-01-552166
PMID: 24829202
PMCID: PMC4192748
ISSN: 0006-4971
eISSN: 1528-0020
Grant note: U10 CA180886 / NCI NIH HHS U10 CA095861 / NCI NIH HHS R01 CA096670 / NCI NIH HHS P30 CA033572 / NCI NIH HHS CA 21765 / NCI NIH HHS UG1 CA189955 / NCI NIH HHS R37 CA036401 / NCI NIH HHS M01-RR00043 / NCRR NIH HHS U10 CA098543 / NCI NIH HHS CA 156449 / NCI NIH HHS R37 CA36401 / NCI NIH HHS U01 GM092666 / NIGMS NIH HHS GM 92666 / NIGMS NIH HHS RC4 CA156449 / NCI NIH HHS P30 CA021765 / NCI NIH HHS M01 RR000043 / NCRR NIH HHS
Language: English
Date published: 10/09/2014
Academic Unit: Stead Family Department of Pediatrics; Hematology/Oncology
Record Identifier: 9984093346702771

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