Comparison of self-report and electronic monitoring of 6MP intake in childhood ALL: a Children's Oncology Group study

被引：34

作者：

Landier, Wendy ^{[1
]}

Chen, Yanjun ^{[1
]}

Hageman, Lindsey ^{[1
]}

Kim, Heeyoung ^{[2
]}

Bostrom, Bruce C. ^{[3
]}

Casillas, Jacqueline N. ^{[4
]}

Dickens, David S. ^{[5
]}

Evans, William E. ^{[6
]}

Maloney, Kelly W. ^{[7
]}

Mascarenhas, Leo ^{[8
]}

Ritchey, A. Kim ^{[9
]}

Termuhlen, Amanda M. ^{[8
]}

Carroll, William L. ^{[10
]}

Relling, Mary V. ^{[6
]}

Wong, F. Lennie ^{[2
]}

Bhatia, Smita ^{[1
]}

机构：

[1] Univ Alabama Birmingham, Dept Pediat, Birmingham, AL USA

[2] City Hope Natl Med Ctr, Dept Populat Sci, Duarte, CA USA

[3] Childrens Hosp & Clin Minnesota, Dept Hematol Oncol, Minneapolis, MN USA

[4] Univ Calif Los Angeles, David Geffen Sch Med, Dept Pediat, Los Angeles, CA 90095 USA

[5] Helen DeVos Childrens Hosp, Spectrum Hlth, Div Pediat Hematol Oncol, Butterworth Campus, Grand Rapids, MI USA

[6] St Jude Childrens Res Hosp, Dept Pharmaceut Sci, 332 N Lauderdale St, Memphis, TN 38105 USA

[7] Univ Colorado, Sch Med, Dept Pediat, Aurora, CO USA

[8] Childrens Hosp Los Angeles, Dept Pediat, Los Angeles, CA 90027 USA

[9] Univ Pittsburgh, Childrens Hosp Pittsburgh, Med Ctr, Dept Pediat, Pittsburgh, PA 15213 USA

[10] NYU, Langone Med Ctr, Perlmutter Canc Ctr, Dept Pediat, New York, NY USA

来源：

BLOOD | 2017年 / 129卷 / 14期

基金：

美国国家卫生研究院;

关键词：

ACUTE LYMPHOBLASTIC-LEUKEMIA; MEDICATION ADHERENCE; SYSTEMIC EXPOSURE; WHITE-CHILDREN; DRUG-THERAPY; MERCAPTOPURINE; 6-MERCAPTOPURINE; RISK; NONADHERENCE; RELAPSE;

D O I：

10.1182/blood-2016-07-726893

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Adequate exposure to oral 6-mercaptopurine (6MP) during maintenance therapy for childhood acute lymphoblastic leukemia (ALL) is critical for sustaining durable remissions; accuracy of self-reported 6MP intake is unknown. We aimed to directly compare self-report to electronic monitoring (Medication Event Monitoring System [MEMS]) and identify predictors of overreporting in a cohort of 416 children with ALL in first remission over 4 study months (1344 patient-months for the cohort) during maintenance therapy. Patients were classified as "perfect reporters" (self-report agreed with MEMS), "overreporters" (self-report was higher than MEMS by >= 5 days/month for >= 50% of study months), and "others" (not meeting criteria for perfect reporter or overreporter). Multivariable logistic regression examined sociodemographic and clinical characteristics, 6MP dose intensity, TPMT genotype, thioguanine nucleotide levels, and 6MP nonadherence (MEMS-based adherence <95%) associated with the overreporter phenotype; generalized estimating equations compared 6MP intake by self-report and MEMS. Self-reported 6MP intake exceeded MEMS at least some of the time in 84% of patients. Fifty patients (12%) were classified as perfect reporters, 98 (23.6%) as overreporters, 2 (0.5%) as underreporters, and 266 (63.9%) as others. In multivariable analysis, the following variables were associated with the overreporter phenotype: non-white race: Hispanic, odds ratio (OR), 2.4, P = .02; Asian, OR, 3.1, P=.02; African American, P<.001; paternal education less than college (OR, 1.4, P=.05); and 6MP nonadherence (OR, 9.4, P<.001). Self-report of 6MP intake in childhood ALL overestimates true intake, particularly in nonadherent patients, and should be used with caution.

引用

页码：1919 / 1926

页数：8

共 35 条

[1] Accuracy of Self-Report and Pill-Count Measures of Adherence in the FEM-PrEP Clinical Trial: Implications for Future HIV-Prevention Trials [J].