Evaluation of compliance to oral chemotherapy in children with acute lymphoblastic leukemia

Background: Drug adherence is an important factor for successful therapy in children with Acute Lymphoblastic Leukemia (ALL). Poor adherence to cytotoxic drugs can cause relapse of the disease, increase therapeutic cost and may lead to death.Aim: Evaluation of adherence to medication in leukemic children in Egypt and identify possible steps to promote adherence in these children.Methods: The study included children with ALL in complete remission at the maintenance phase of chemotherapy and taken 6-Mercaptopurine (6-MP) daily oral dose. Evaluation was done through specific questionnaire to the patient or his caregiver which included details about the child, his family, his illness and details about the medication given and its circumstances. Also, determination of 6-Mercaptopurine metabolites in blood was done for all children using thin layer chromatography (TLC).Results: Forty three children with ALL were included in this study, 22 male and 21 female with age at diagnosis ranged from 19 months to 11 2 years.Nonadherence was detected by 6-MP level in 52.2% of cases, -ve results obtained in 9 patient (20.9%) and very low levels (≤4.5ng) in 5 patients (11.6%), and 58.1% detected as nonadherent by questionnaire.Nonadherence was significantly associated with low socioeconomic level (83.3%) and low educational level (73.7% by questionnaire and 57.9% by 6-MP level), Forgetfulness is the main cause of nonadherence (48%), followed by refusal of the child to take medication (24%),other causes include negligence (12%) and drug unavailability(12%).Mothers were the