A Home-based Maintenance Therapy Program for Acute Lymphoblastic Leukemia-Practical and Safe?

The maintenance phase of treatment for childhood acute lymphoblastic leukemia is characterized by daily oral chemotherapy dose-adjusted on the basis of toxicity, monitored by regular (1 to 2 weekly) blood counts. A traditional approach is undertaking this at out-patient clinics. A home maintenance program was commenced to reduce visits to hospital and associated family disruption. The program organizes blood tests arranged to be taken at or near the patients' home. The results are examined by a pharmacist and specialist nurse; changes in therapy are communicated by telephone call and written confirmation. Hospital attendance is reduced to monthly visits. To assess the program, tablet counting and before-and-after audits of parental satisfaction were undertaken. Results of the first 2 years are presented. Preliminary analysis to identify predictors of nonadherence was performed. Fifty families were included in the evaluation. There were no critical incidents. Poor adherence rates in the initial 3-month period (overall 24%) improved after increased support and advice were offered to 78%. Increasing age was correlated with good adherence (r = 0.37, P = 0.02). Partnership status of the child's caretakers was strongly associated with adherence (14% of poor adhering patients had caretakers in stable partnerships, compared with 87% of good adhering patients, P < 0.01).