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6-MP based maintenance therapy of childhood ALL in Slovenia : a retrospective study from 1970 to 2004
Karas Kuželički, Nataša (Author), Šmid, Alenka (Author), Mlinarič-Raščan, Irena (Author), Jazbec, Janez (Author)

URLURL - Presentation file, Visit http://vestnik.szd.si/index.php/ZdravVest/article/view/1016 This link opens in a new window

Abstract
Maintenance therapy with 6-mercaptopurine (6-MP) as its major component has been one of the main reasons for the drastic increase in overall survival of paediatric patients with acute lymphoblastic leukaemia (ALL). In our cohort, consisting of patients receiving maintenance therapy for ALL and encompassing time period of three decades, we evaluated dosage, safety and efficiency of 6-MP in the treatment of childhood ALL according to treatment protocol, age and gender. Slovenian paediatric ALL patients diagnosed and treated from 1970 to 2004 were identified through the national oncology patients` registry. Of 414 registered paediatric ALL patients, 320 received maintenance therapy for ALL and were included in the final study cohort. Information about age, gender, treatment protocol, 6-MP related toxic events and ALL relapse was extracted from patients` files. Differences in 6-MP dose reduction, 6-MP side effects and relapse according togender, age and treatment protocol were statistically evaluated. After adjustment for gender and age, the incidence of 6-MP dose reduction (p <0.001) and bone marrow suppression (p = 0.019) was higher in recent treatment protocols, while relapse was more common in older protocols (p < 0.001). Younger patients had greater risk for sepsis/infection (p = 0.002), while greater age was a risk factor for osteonecrosis (p = 0.001). No statistically significant associations were found according to gender. In the retrospective study, encompassing three decades of maintenance treatment of childhood ALL in Slovenia, recent protocols exhibited greater effectiveness and toxicity than older protocols.

Language:English
Keywords:6-merkaptopurin, akutna limfoblastna levkemija, otroci, protokoli zdravljenja, relaps, stranski učinki, tiopurini
Work type:Not categorized (r6)
Tipology:1.01 - Original Scientific Article
Organization:FFA - Faculty of Pharmacy
Year:2015
Publisher:Slovensko zdravniško društvo
Number of pages:str. 99-107
Numbering:Letn. 84, št. 2
UDC:616.155.392-006.44-085
ISSN on article:1318-0347
COBISS.SI-ID:3839089 Link is opened in a new window
Views:471
Downloads:162
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Record is a part of a journal

Title:Zdravniški vestnik
Publisher:Slovensko zdravniško društvo
ISSN:1318-0347
COBISS.SI-ID:32893696 This link opens in a new window

Secondary language

Language:Slovenian
Title:Uporaba 6-merkaptopurina v vzdrževalni fazi zdravljenja ALL pri otrocih v Sloveniji
Abstract:
Vzdrževalno zdravljenje s 6-merkaptopurinom (6-MP) je eden od vodilnih vzrokov za drastično povečanje stopnje preživetja pediatričnih bolnikov z akutno limfoblastno levkemijo (ALL). V študiji smo retrospektivno ovrednotili odmerke 6-MP, varnost in učinkovitost vzdrževalnega zdravljenja pri otrocih z ALL glede na starost, spol in protokol zdravljenja v obdobju tridesetih let. Pediatrične bolnike, ki so se med letoma 1970 in 2004 v Sloveniji zdravili za ALL, smo identificirali s pomočjo nacionalnega registra raka. Od 414 registriranih bolnikov jih je 320 prejelo vzdrževalno zdravljenje za ALL in smo jih vključili v končno študijsko populacijo. Iz bolniških kartonov smo pridobili informacije o starosti, spolu, protokolu zdravljenja, stranskih učinkih 6-MP in relapsu bolezni. Statistično smo ovrednotili razlike v zmanjšanju odmerka 6-MP, toksičnih učinkih 6-MP in relapsu ALL glede na spol, starost in protokol zdravljenja. Ob upoštevanju starosti in spola sta bila zmanjšanje odmerka 6-MP (p < 0.001) in zavora kostnega mozga (p = 0.019) bolj pogosta pri bolnikih, ki so bili zdravljeni z novejšimi protokoli zdravljenja, medtem ko je bilo več relapsov v starejših protokolih (p < 0.001). Mlajši bolniki so bili bolj nagnjeni k sepsi in infekcijam (p = 0.002), medtem ko je bila osteonekroza bolj pogosta pri starejših (p = 0.001). Noben izmed preiskovanih dejavnikov pa se ni statistično značilno razlikoval med spoloma. V retrospektivni študiji, ki zajema tri desetletja vzdrževalnega zdravljenja otroške ALL v Sloveniji, so se novejši protokoli zdravljenja izkazali za bolj učinkovite, vendar tudi bolj toksične, kot starejši protokoli.

Keywords:akutna limfoblastna levkemija, 6-merkaptopurin, tiopurini, stranski učinki, relaps, protokoli zdravljenja, otroci

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