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CC BY 4.0 · Indian J Med Paediatr Oncol 2025; 46(03): 297-304
DOI: 10.1055/s-0044-1790580
Original Article

Effect of Smart Pill Box on Improving Adherence to 6-Mercaptopurine Maintenance Therapy in Pediatric ALL

Authors

  • S. Abhilasha 

    1   Department of Medical Oncology, KAHER'S Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

  • Apoorva Bagalkotkar 

    2   Department of Pediatrics, KAHER's Jawaharlal Nehru Medical College (JNMC), Belagavi, Karnataka, India

Funding None.
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Abstract

Introduction 6-Mercaptopurine (6-MP) forms the backbone of maintenance chemotherapy for acute lymphoblastic leukemia (ALL). A Children's Oncology Group study found 3.9-fold increased risk of relapse in children with 6-MP adherence less than 90%.

Objective This article estimates the impact of smart pill box in improving adherence to 6-MP during maintenance phase chemotherapy in children with ALL.

Materials and Methods It is a prospective interventional study done at pediatric oncology clinic of a tertiary care hospital. Participants being 40 newly diagnosed children with ALL. Baseline adherence was assessed and impact of smart pill box was estimated after using it for 60 days. Subjective and objective assessment of baseline adherence and adherence after intervention was done by subjecting the parents of the children to Morisky Medication Adherence Score 8 (MMAS-8) and measurement of patient's red blood cells (RBC) 6-MP metabolites (6-thioguanine [TGN] and 6-methylmercaptopurine [MMP]) levels, respectively, pre- and postintervention.

Results The mean age was 7.39 ± 4.29 years. NUDT15*3 polymorphism was present in 10.26%, and none had TPMT polymorphism. Baseline assessment of adherence to 6-MP by MMAS-8 revealed low, medium, and high adherence in 7.5, 35, and 57.5%, respectively. Baseline 6-TGN and 6-MMP levels by cluster analysis revealed poor adherence in 10%. Following intervention, mean MMAS-8 improved from 7.34 ± 0.78 to 7.66 ± 0.55 (p-value < 0.015) and the median 6-TGN level improved from 150 to 253 pmol/8 × 108 RBCs (p-value < 0.001).

Conclusion Nonadherence to 6-MP is widely prevalent in Indian children. Simple measures like smart pill box can improve adherence.

Keywords

ALL - maintenance chemotherapy - adherence - smart pill box - 6MP metabolites

Patient Consent

Informed patient consent was obtained for this study.


Supplementary Material



Publication History

Article published online:
30 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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