Abstract
ObjectiveStudies on children with Acute Lymphoblastic Leukemia (ALL) reported non-adherence in 2–54% of cases. The primary objective of this study was to assess rates of adherence to 6-MP using two different methods in children and adolescents with ALL. Secondary aim was to identify factors that influence adherence to 6-MP in children with ALL.MethodsAll eligible children with ALL who are (≤ 19) years old and receive 6-MP therapy for at least 1 month were approached to participate in the study. A total of 52 children with ALL and their primary caregivers were recruited. Adherence measures included an objective method (measuring 6-MP metabolites in packed Red Blood Cells (RBCs)) and a subjective method (using parent and child self-report via the Medication Adherence Report Scale; MARS; Adherence was defined as 90% or greater).ResultsRates of adherence varied across the measurement methods. Packed RBCs sample analysis indicated forty-four patients (84.6%) to be adherent. Using the MARS questionnaires, a total of 49 children (94.2%) were classified as being adherent according to the parental MARS questionnaire scores, while all the 15 children (100%) who answered the MARS (child) questionnaire were classified as adherent. Overall adherence rate was 80.8% within the studied population.ConclusionMARS scale was shown to overestimate adherence compared to measurement of 6-MP metabolites in the blood. A combination of both methods led to increased detection of non-adherence to thiopurine in children with ALL.
Highlights
Acute lymphoblastic leukemia (ALL) is the most common cancer in children[1]
Adherence measures included an objective method (measuring 6-MP metabolites in packed Red Blood Cells (RBCs)) and a subjective method
Using the Medication Adherence Report Scale (MARS) questionnaires, a total of 49 children (94.2%) were classified as being adherent according to the parental MARS questionnaire scores, while all the 15 children (100%) who answered the MARS questionnaire were classified as adherent
Summary
Acute lymphoblastic leukemia (ALL) is the most common cancer in children[1]. Maintenance therapy in ALL consists of daily doses of 6-mercaptopurine (6-MP), weekly methotrexate interrupted by monthly pulses of vincristine and dexamethasone[2]. 6-MP is considered the most monitored treatment due to its daily administration and stable intracellular metabolites[3]. 6-MP is a drug with cytotoxic effects that has a short half-life (1.5 hours), so measuring its plasma level cannot be used to assess drug effect. Poor adherence to medication treatment is a recognised problem in paediatric patients, where non-adherence rates are reported to range from 25% to 60% [7,8,9,10]. Studies in children and adolescents with ALL reported non-adherence to 6-MP in 17–46% of the cases [3,12,13,14]. This problem has several negative consequences such as repeated clinic visits, extended course of illness, poorly controlled symptoms and increased cost due, for example, to unnecessary hospital admissions[15]. Non-adherence is a significant concern in all illnesses especially in patients with chronic conditions, including children
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