AI Article Synopsis
- Pediatric acute lymphoblastic leukemia (ALL) has a high cure rate of about 90% in developed countries, with treatment involving 6-8 months of intensive chemotherapy followed by 24 months of maintenance therapy using drugs like 6-mercaptopurine (6MP) and methotrexate (MTX).
- The goal of maintenance therapy is to administer the highest tolerated doses of these medications, requiring regular monitoring and adjustments based on individual patient tolerance and blood counts.
- Challenges in treatment adherence and drug tolerance can lead to poor outcomes, emphasizing the need for careful management and monitoring to minimize interruptions and optimize dosing, particularly in the Indian healthcare context.
Article Abstract
Cure rates in pediatric acute lymphoblastic leukemia (ALL) currently approach 90% in the developed world. Treatment involves 6-8 mo of intensive multi-drug chemotherapy followed by 24 mo of maintenance treatment (ALL-MT). The cornerstone of ALL-MT is the daily administration of oral 6-mercaptopurine (6MP), a purine analogue. 6MP is combined with weekly oral methotrexate (MTX), an antifolate drug, to augment therapeutic activity. Some protocols include additional chemotherapy drugs (such as vincristine and corticosteroids) during MT. The objective of ALL-MT is to ensure uninterrupted treatment at the highest tolerated doses of 6MP and MTX. This requires periodic adjustments of 6MP and MTX doses throughout treatment. Tolerance is determined through regular clinical assessments and careful monitoring of blood counts. Tolerated drug doses vary widely among patients, influenced by genetic and non-genetic factors, and require individualized dosing. Suboptimal treatment intensity in ALL-MT is associated with inferior outcomes and results from failure to treat at highest tolerated drug doses and/or interruptions in treatment due to non-adherence or toxicity. Management of MT thus requires close supervision to ensure treatment adherence, periodic drug dose modifications, and treatment to tolerance, while minimizing treatment interruptions due to toxicity. The review highlights these challenges and discusses approaches and strategies for the management of MT, focusing on the Indian context.
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