Abstract
Despite significant improvement in the induction of treatment for ALL relapse rates during maintenance therapy are still relatively high. Putative mechanisms for maintenance failure include patients' compliance, pharmacokinetic variability of 6 mercapto purine (6MP) and methotrexate (MTX), as well as differences in tumor sensitivity. However, the issue of physicians' compliance with the recommended doses of chemotherapy as a factor affecting outcome has not yet been addressed. We studied the prescription patterns of maintenance therapy for children with ALL and their association with duration of complete remission. Both 6MP and MTX were prescribed in doses significantly lower than those recommended during maintenance therapy. Out of 212 evaluated patients, relapsed patients (n = 101) received significantly less MTX as compared to nonrelapsed patients (n = 111) during the first 2 years of maintenance therapy (p<.05).In the group of standard risk patients who received the same induction therapy (n = 92), 11/17 (64%) of those receiving less than 50% of their recommended MTX dose relapsed, significantly more than those receiving more than 50% of the dose (28/75;37%) (p<0.05).It is concluded that physicians' failure to adhere to the recommended protocol is associated with a higher relapse rate of ALL. Improved physicians' compliance may improve the prognosis of this fatal disease.
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