Nonadherence to Oral Mercaptopurine and Risk of Relapse in Hispanic and Non-Hispanic White Children With Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group

Smita BHATIA; Wendy LANDIER; Leo MASCARENHAS; A Kim Ritchey; Jacqueline N CASILLAS; David S DICKENS; Jane MEZA; William L CARROLL; Mary V RELLING; F LENNIE WONG; Muyun SHANGGUAN; Lindsey HAGEMAN; Alexandra N SCHAIBLE; Andrea R CARTER; Cara L HANBY; Wendy LEISENRING; Yutaka YASUI; Nancy M KORNEGAY

doi:10.1200/JCO.2011.38.9924

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Nonadherence to Oral Mercaptopurine and Risk of Relapse in Hispanic and Non-Hispanic White Children With Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group

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Nonadherence to Oral Mercaptopurine and Risk of Relapse in Hispanic and Non-Hispanic White Children With Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group

Smita BHATIA, Wendy LANDIER, Leo MASCARENHAS, A Kim Ritchey, Jacqueline N CASILLAS, David S DICKENS, Jane MEZA, William L CARROLL, Mary V RELLING, F LENNIE WONG, …

Journal of clinical oncology, Vol.30(17), pp.2094-2101

2012

DOI: 10.1200/JCO.2011.38.9924

PMCID: PMC3601449

PMID: 22564992

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Abstract

Purpose Systemic exposure to mercaptopurine (MP) is critical for durable remissions in children with acute lymphoblastic leukemia (ALL). Nonadherence to oral MP could increase relapse risk and also contribute to inferior outcome in Hispanics. This study identified determinants of adherence and described impact of adherence on relapse, both overall and by ethnicity. Patients and Methods A total of 327 children with ALL (169 Hispanic; 158 non-Hispanic white) participated. Medication event-monitoring system caps recorded date and time of MP bottle openings. Adherence rate, calculated monthly, was defined as ratio of days of MP bottle opening to days when MP was prescribed. Results After 53,394 person-days of monitoring, adherence declined from 94.7% (month 1) to 90.2% (month 6; P < .001). Mean adherence over 6 months was significantly lower among Hispanics (88.4% v 94.8%; P < .001), patients age ≥ 12 years (85.8% v 93.1%; P < .001), and patients from single-mother households (80.6% v 93.1%; P = .001). A progressive increase in relapse was observed with decreasing adherence (reference: adherence ≥ 95%; 94.9% to 90%: hazard ratio [HR], 4.1; 95% CI,1.2 to 13.5; P = .02; 89.9% to 85%: HR, 4.0; 95% CI, 1.0 to 15.5; P = .04; < 85%: HR. 5.7; 95% CI, 1.9 to 16.8; P = .002). Cumulative incidence of relapse (± standard deviation) was higher among Hispanics (16.5% ± 4.0% v 6.3% ± 2.2%; P = .02). Association between Hispanic ethnicity and relapse (HR, 2.6; 95% CI, 1.1 to 6.1; P = .02) became nonsignificant (HR, 1.8; 95% CI, 0.6 to 5.2; P = .26) after adjusting for adherence and socioeconomic status. At adherence rates ≥ 90%, Hispanics continued to demonstrate higher relapse, whereas at rates < 90%, relapse risk was comparable to that of non-Hispanic whites. Conclusion Lower adherence to oral MP increases relapse risk. Ethnic difference in relapse risk differs by level of adherence—an observation currently under investigation.

Tumors

Hematologic and hematopoietic diseases

Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis

Biological and medical sciences

Medical sciences

Details

Title: Subtitle: Nonadherence to Oral Mercaptopurine and Risk of Relapse in Hispanic and Non-Hispanic White Children With Acute Lymphoblastic Leukemia: A Report From the Children's Oncology Group
Creators: Smita BHATIA - City of Hope, Duarte, United States
Wendy LANDIER - City of Hope, Duarte, United States
Leo MASCARENHAS - University of Southern California Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
A Kim Ritchey - Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
Jacqueline N CASILLAS - University of California, Los Angeles, United States
David S DICKENS - Spectrum Health at Butterworth Campus, Grand Rapids, MI, United States
Jane MEZA - University of Nebraska Medical Center, Omaha, NE, United States
William L CARROLL - New York University Cancer Institute, New York, NY, United States
Mary V RELLING - St Jude Children's Research Hospital, Memphis, TN, United States
F LENNIE WONG - City of Hope, Duarte, United States
Muyun SHANGGUAN - City of Hope, Duarte, United States
Lindsey HAGEMAN - City of Hope, Duarte, United States
Alexandra N SCHAIBLE - City of Hope, Duarte, United States
Andrea R CARTER - David Geffen School of Medicine, University of California, Los Angeles, United States
Cara L HANBY - City of Hope, Duarte, United States
Wendy LEISENRING - Fred Hutchinson Cancer Research Center, Seattle, WA, United States
Yutaka YASUI - University of Alberta, Edmonton, Alberta, Canada
Nancy M KORNEGAY - St Jude Children's Research Hospital, Memphis, TN, United States
Resource Type: Journal article
Publication Details: Journal of clinical oncology, Vol.30(17), pp.2094-2101
Publisher: American Society of Clinical Oncology
DOI: 10.1200/JCO.2011.38.9924
PMID: 22564992
PMCID: PMC3601449
ISSN: 0732-183X
eISSN: 1527-7755
Language: English
Date published: 2012
Academic Unit: Stead Family Department of Pediatrics; Hematology/Oncology
Record Identifier: 9984093227702771

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