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KMID : 0939920230550031023
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대한암학회지
2023 Volume.55 No. 3 p.1023 ~ p.1030
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Clinical Impact of Drug Adherence of Tyrosine Kinase Inhibitors in Children with Ph-Positive Acute Lymphoblastic Leukemia
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Jun-Xia Wang
Miao-Miao Yang
Li-Peng Liu
Hui-Min Zhang
Meng-Chuan Wang
Yu-Wen Chen
Xiao-Ying Zang
Fang Hu
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Abstract
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Purpose : This study aimed to explore the impact of ABL1?tyrosine kinase inhibitors (TKIs) adherence on the survival of chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) children and clarify the potential predictors of patients’ prognosis from TKIs intake practices.
Materials and Methods : Ninety newly diagnosed Ph+ ALL patients who received TKIs were enrolled. We collected the baseline characteristics and adverse events in all children; moreover, TKIs adherence was measured by an eight-item Morisky medication adherence scale (MMAS-8). Progression-free survival (PFS) and overall survival (OS) analysis were performed, and risk factors for PFS and OS were evaluated.
Results : Among all patients, 69 cases were regarded as adherers, while 21 were non-adherers. The median duration of TKIs interruption was significantly prolonged in the non-adherence group than in the adherence group (13 [0?101] vs. 56 [11?128], p < 0.001). Additionally, dose reduction occurred in 55.2% of non-adherers versus 23.0% of adherers (p=0.002). The PFS and OS in adherers were significantly higher versus non-adherers (p=0.020 and p=0.039). MMAS-8 score was an independent risk factor for PFS (p=0.010) and OS (p=0.031). Among non-adherers, the median OS was only 23.1% (4.2%?42%) in patients aged ≤ 10 years versus 54.4% (38.8%?70%) in adolescents. Most of the patients who experienced TKIs non-adherence suffered pancytopenia.
Conclusion : TKIs adherence during treatment significantly influenced the survival of pediatric Ph+ ALL patients, and non-adherers with age ≤ 10 years were more vulnerable to TKIs disruption. The cumulative TKIs dose should be especially emphasized to patients with age ≤ 10 years, which may result in an inferior achievement of relevant treatment milestones.
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KEYWORD
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Ph-positive, Acute lymphoblastic leukemia, Children, Tyrosine kinase inhibitors, Adherence
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