Understanding Medication Adherence in Pediatric Acute Lymphoblastic Leukemia: A Review

Pritchard, Michelle T; Butow, Phyllis; Stevens, Michael; Duley, John A.

doi:10.1097/01.mph.0000243666.79303.45

Cited by 54 publications

(54 citation statements)

References 48 publications

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“…The rate of nonadherence could not be precisely studied here with the small sample size necessary for the mixed methodology chosen, which combined in-depth interviews and self-administered questionnaires. It is also difficult to compare this nonadherence rate with previous studies that used different definitions of adherence [18]. However, these results confirm that adherence toward leukemia maintenance therapy is sometimes inadequate, as has been described in several studies [4][5][6][7][8][9][10][11][12][13].…”

Section: Discussionsupporting

confidence: 50%

“…There is no operational definition of leukemia maintenance therapy adherence [18], although the risk of relapse depends on the maintenance treatment quality [14][15][16]. The physician evaluation finally may be more pragmatic and efficient, as we cannot be sure when forgetfulness is sufficient to impair the chances of recovery.…”

Section: mentioning

confidence: 99%

“…Adolescents may be the least likely to adhere to therapy [1]. In the particular context of oral antineoplastic chemotherapy, nonadherence is higher among adolescents than among children [2,12,18,19]. It is unclear whether nonadherence is also higher among adolescents than among adults.…”

Section: Introductionmentioning

confidence: 99%

“…The time since the start of maintenance therapy was similar between the two groups (11 months for adherent patients vs. 16 months[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] for nonadherent patients; P = .188).…”

mentioning

confidence: 99%

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Adherence to Leukemia Maintenance Therapy: A Comparative Study Among Children, Adolescents, and Adults

Mancini

Siméoni²,

Parola

et al. 2012

Pediatric Hematology and Oncology

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This study describes patient adherence to leukemia maintenance therapy and the factors associated with nonadherence, with a particular focus on the different age groups concerned. Sixty-four in-depth interviews were performed in three centers among 31 parents of children, 12 parents of adolescents, 12 adolescents, and 9 adult patients. Adherence was determined through a multimethod approach based on patient and/or parent responses to three self-administered questions and patient and/or parent interviews. The results were compared with physician evaluation of adherence. Factors explaining nonadherence were investigated in the in-depth interviews and by statistical analysis of self-administered questionnaires. Intentional nonadherence occurred rarely (4/52 patients, 8%) following poor tolerance of the maintenance therapy. Despite a high motivation to follow the maintenance therapy, repeated forgetfulness (8/52, 15%) was not rare and rarely detected by physicians. Nonadherence increased with age, but also existed among children. Outings, the administration of therapy at bedtime, the lack of monitoring, a low socioeconomic status, and the hepatic side effects of the treatment were also associated with nonadherence. Declared nonadherence of leukemia maintenance therapy is not negligible and should be screened at follow-up consultations using three simple questions.

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Section: Discussionsupporting

confidence: 50%

Section: mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Adherence to Leukemia Maintenance Therapy: A Comparative Study Among Children, Adolescents, and Adults

Mancini

Siméoni²,

Parola

et al. 2012

Pediatric Hematology and Oncology

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“…39 Second, poor patient compliance to the prescribed oral doses of 6MP/MTX has been indicated as a risk factor for relapse. [40][41][42] Social, psychological and medical disorders may influence to which extent adolescents take their prescribed therapy, 43 and the problem is not trivial. Both electronic monitoring 40 and drug metabolite measurements 44 have indicated that 10-20% of childhood ALL patients intermittently fail to take their oral medication, with a few percent being consistently non-compliant, a problem that seems more frequent among adolescents.…”

Section: Discussionmentioning

confidence: 99%

The degree of myelosuppression during maintenance therapy of adolescents with B-lineage intermediate risk acute lymphoblastic leukemia predicts risk of relapse

et al. 2010

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Drug doses, blood levels of drug metabolites and myelotoxicity during 6-mercaptopurine/methotrexate (MTX) maintenance therapy were registered for 59 adolescents (X10 years) and 176 non-adolescents (o10 years) with B-cell precursor acute lymphoblastic leukemia (ALL) and a white blood cell count (WBC) o50 Â 10 9 /l at diagnosis. Event-free survival was lower for adolescents than non-adolescents (pEFS 12y :0.71 vs 0.83, P ¼ 0.04). For adolescents staying in remission, the mean WBC during maintenance therapy (mWBC) was related to age (r S ¼ 0.36, P ¼ 0.02), which became nonsignificant for those who relapsed (r S ¼ 0.05, P ¼ 0.9). The best-fit multivariate Cox regression model to predict risk of relapse included mWBC and thiopurine methyltransferase activity, which methylates mercaptopurine and reduces the intracellular availability of cytotoxic 6-thioguanine nucleotides (coefficient: 0.11, P ¼ 0.02). The correlation of mWBC to the risk of relapse was more pronounced for adolescents (coefficient ¼ 0.65, P ¼ 0.003) than for non-adolescents (coefficient ¼ 0.42, P ¼ 0.04). Adolescents had higher mean neutrophil counts (P ¼ 0.002) than nonadolescents, but received nonsignificantly lower mercaptopurine and MTX doses during maintenance therapy. Red blood cell MTX levels were significantly related to the dose of MTX among adolescents who stayed in remission (r S ¼ 0.38, P ¼ 0.02), which was not the case for those who developed a relapse (r S ¼ 0.15, P ¼ 0.60). Thus, compliance to maintenance therapy may influence the risk of relapse for adolescents with ALL.

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Augmented Berlin‐Frankfurt‐Münster therapy in adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL)

Rytting

Thomas

O’Brien³

et al. 2014

Cancer

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Background Various trials report improved outcomes for adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated with pediatric- based regimens. This prompted the investigation of the pediatric Augmented Berlin-Frankfurt-Münster (ABFM) regimen in AYA patients. Results were compared with the hyper–fractionated cyclophosphamide, vincristine, Adriamycin and dexamethasone (hyper-CVAD) regimen in a similar population. Methods Eighty-five patients age 12 to 40 years with Philadelphia chromosome- (Ph) negative ALL were treated with ABFM from 10/2006 through 4/2012. Their outcome was compared to 71 historical AYA patients treated with hyper-CVAD from our institution. Patient and disease characteristics, as well as status of minimal residual disease (MRD), were analyzed for their impact on outcomes. Results The complete remission (CR) rate with ABFM was 94%. The 3-year complete remission duration (CRD) and overall survival (OS) rates were 70% and 74%, respectively. The 3-year CRD and OS were 72% and 85%, respectively, with age ≤ 21 years, and 69% and 60%, respectively, with age 21-40 years. Initial white blood cell count was an independent predictive factor of OS and CRD. The MRD status on Day 29 and Day 84 of therapy were also predictive of long-term outcomes. Severe regimen toxicities included transient hepatotoxicity in 35-39%, pancreatitis in 11%, osteonecrosis in 11%, and thrombosis in 22%. The 3-year OS rate was 74% with ABFM versus 71% with hyper-CVAD; the 3-year CRD rate was 70% with ABFM versus 66% with hyper-CVAD. Conclusion ABFM was tolerable in AYA patients with ALL but was not associated with significant improvements in CRD and OS compared with hyper-CVAD.

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Understanding Medication Adherence in Pediatric Acute Lymphoblastic Leukemia: A Review

Cited by 54 publications

References 48 publications

Adherence to Leukemia Maintenance Therapy: A Comparative Study Among Children, Adolescents, and Adults

Adherence to Leukemia Maintenance Therapy: A Comparative Study Among Children, Adolescents, and Adults

The degree of myelosuppression during maintenance therapy of adolescents with B-lineage intermediate risk acute lymphoblastic leukemia predicts risk of relapse

Augmented Berlin‐Frankfurt‐Münster therapy in adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL)

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