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Durable remissions in children with acute lymphoblastic leukemia (ALL) require a 2-year maintenance phase that includes daily oral 6-mercaptopurine (6MP). Adherence to oral 6MP among Asian-American and African-American children with ALL is unknown. We enrolled 298 children with ALL (71 Asian Americans, 68 African Americans, and 159 non-Hispanic whites) receiving oral 6MP for the maintenance phase. Adherence was measured electronically for 39 803 person-days. Adherence declined from 95. 0% (month 1) to 91. 8% (month 5, P <. 0001). Adherence rates were significantly (P <. 0001) lower in Asian Americans (90. 0% ± 4. 9%) and African Americans (87. 1% ± 4. 4%), as compared with non-Hispanic whites (95. 2% ± 1. 3%). Race-specific sociodemographic characteristics helped explain poor adherence (African Americans: low maternal education less than a college degree: 78. 9%, vs at least college degree: 94. 6%; P <. 0001; Asian Americans: low-income households <50 000: 84. 5%, vs ≥50 000: 96. 7%; P =. 04; households without mothers as full-time caregivers 85. 6% vs households with mothers as full-time caregivers 97. 2%; P =. 05). Adherence rate below 90% was associated with increased relapse risk (hazard ratio, 3. 9; P =. 01). Using an adherence rate <90% to define nonadherence, 20. 5% of the participants were nonadherers. We identify race-specific determinants of adherence, and define a clinically relevant level of adherence needed to minimize relapse risk in a multiracial cohort of children with ALL. This trial was registered at www. clinicaltrials. gov as #NCT00268528.
Bhatia et al. (Thu,) studied this question.