Nonadherence triple risk of relapse in African-American and Asian children with ALL in remission

Nonadherence triple risk of relapse in African-American and Asian children with ALL in remission -

nonadherence triple risk of relapse, more common in African American and Asian children

an estimated 25 percent of children in remission from acute lymphoblastic leukemia (ALL) are missing too many doses of essential maintenance medication that minimizes the risk of relapse according to a study published online today in Blood , the Journal of the American Society of Hematology. The study also indicates that maintenance medication adherence was lower among African-American and Asian children in remission from ALL than in non-Hispanic white children, with 46 percent of African Americans and 28 percent of Asians not taking enough to prevent relapse, compared with 14 percent of non-Hispanic whites.

acute lymphocytic leukemia (ALL), a cancer of white blood cells, is the most common form of cancer in children. While more than 95 percent of children with ALL enter remission within a month of receiving the initial treatment of cancer, one in five people will relapse. In order to remain cancer free, children in remission from ALL must take oral form of chemotherapy every day for two years (known as 6-mercaptopurine or 6MP) that protects the body against the re-emergence of the disease.

Despite the proven benefits of 6MP, previous studies have suggested that children with ALL have difficulty taking the drug regularly. Other studies have reported that pediatric ALL survival rates vary widely between racial groups. These two ideas have prompted researchers to begin studying specific models to race in 6MP adherence in children with ALL.

"Although we do not yet know why the children of different races have significantly different survival rates for all we know they joined their maintenance drugs is a key factor in their survival," said lead study author Smita Bhatia, MD, MPH, of City of Hope in Duarte, Calif. "in this spirit, we sought to investigate potential links that may exist between several specific key sociodemographic race of these children and their adherence to 6MP. "

Dr. Bhatia and a team of investigators began their research to study the differences 6MP adhesion between the different racial groups of children in remission of ALL in 2012, reports that Hispanic children were not following maintenance regime as prescribed 6MP consistent than non-Hispanic whites. to examine 6MP membership African-American, Asian and non-Hispanic white children in remission of all, the research team enrolled 298 patients 77 institutions in a study that followed 6MP drug levels in the bloodstream, the answers of a questionnaire administered to their families and, perhaps more importantly, an electronic method for tracking maintenance. Each patient included in the study, which was prescribed 6MP, came with a pill bottle fitted with a microprocessor chip in the cap that recorded each date and time of the bottle has been opened for a period six months.

for the three groups, African-American children took their 6MP least often, with 46 percent of them taking 0 percent or less of their medication, nonadherence during threshold which the relapse risk became statistically significant. While Asian children in the study group took their medication more consistently, 28 percent of them did not take at least 0 percent of their drugs. non-Hispanic white children were more adherent to their maintenance treatment regimen than any other group; However, 14 percent still did not 6MP enough to meet the criterion of researchers to adherence. Taken together, about 25 percent of children enrolled in the study did not take their 6MP at least 0 percent of the time, tripling their risk of relapse.

To better understand the socio-demographic factors that have influenced the drug nonadherence in children, the researchers asked their families to complete questionnaires to provide more information on race, income, the structure of the family, and the level of parental education. Responses to the questionnaire revealed that African American kids came largely from low income family households with lower education level parent (less than college training / professional degree). Conversely, Asian children in general have come to high-income nuclear families with educated parents (college diploma / vocational or postgraduate degree). Despite representing two demographic extremes, neither group adhered to their medication consistently as non-Hispanic white children, who reported a moderate income, relatively nuclear family structure, and the average parental education compared to other groups, in part because the specific demographics race played an important role in respect of 6MP.

researchers observed that 6MP adherence rates were significantly higher in Asian children and African-American who came from households where their mother acted as their full-time caregiver and supervisor drugs . Furthermore, according to the research data, African American children whose mothers had relatively low levels of education, as well as children living in a single parent, multiple-children households were less adherent to their medications. The researchers also noted that Asian children were more vulnerable to medication nonadherence if they were from low-income households and non-Hispanic whites did not take their medications as always if their fathers had a low level of education.

Regardless of race, families have reported that the most common reason for children not taking their medications 6MP was forgotten.

"Our data show that one in four children in remission from ALL do not take the drugs needed to stay cancer free, and overwhelmingly, the main reason why they forget to take their pills every day, "said Dr. Bhatia. "These results are the basis for other studies that examine how physicians can intervene successfully using technology, for example, that children do not know an increased risk of relapse because they take their chemotherapy oral. "