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

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)2345-2353
Number of pages9
JournalBlood
Volume124
Issue number15
DOIs
StatePublished - Oct 9 2014

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6-Mercaptopurine
Oncology
Asian Americans
Precursor Cell Lymphoblastic Leukemia-Lymphoma
African Americans
Mothers
Caregivers
Hazards
Education
Recurrence
Odds Ratio
Maintenance

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Bhatia, S., Landier, W., Hageman, L., Kim, H., Chen, Y., Crews, K. R., ... Relling, M. V. (2014). 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: A Children's Oncology Group study. Blood, 124(15), 2345-2353. https://doi.org/10.1182/blood-2014-01-552166

6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia : A Children's Oncology Group study. / Bhatia, Smita; Landier, Wendy; Hageman, Lindsey; Kim, Heeyoung; Chen, Yanjun; Crews, Kristine R.; Evans, William E.; Bostrom, Bruce; Casillas, Jacqueline; Dickens, David S.; Maloney, Kelly W.; Neglia, Joseph P.; Ravindranath, Yaddanapudi; Ritchey, A. Kim; Wong, F. Lennie; Relling, Mary V.

In: Blood, Vol. 124, No. 15, 09.10.2014, p. 2345-2353.

Research output: Contribution to journalArticle

Bhatia, S, Landier, W, Hageman, L, Kim, H, Chen, Y, Crews, KR, Evans, WE, Bostrom, B, Casillas, J, Dickens, DS, Maloney, KW, Neglia, JP, Ravindranath, Y, Ritchey, AK, Wong, FL & Relling, MV 2014, '6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: A Children's Oncology Group study', Blood, vol. 124, no. 15, pp. 2345-2353. https://doi.org/10.1182/blood-2014-01-552166
Bhatia, Smita ; Landier, Wendy ; Hageman, Lindsey ; Kim, Heeyoung ; Chen, Yanjun ; Crews, Kristine R. ; Evans, William E. ; Bostrom, Bruce ; Casillas, Jacqueline ; Dickens, David S. ; Maloney, Kelly W. ; Neglia, Joseph P. ; Ravindranath, Yaddanapudi ; Ritchey, A. Kim ; Wong, F. Lennie ; Relling, Mary V. / 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia : A Children's Oncology Group study. In: Blood. 2014 ; Vol. 124, No. 15. pp. 2345-2353.
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abstract = "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.",
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T1 - 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia

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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

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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.

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