{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:13:39Z","timestamp":1789017219714,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:00:00Z","timestamp":1632960000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007403","name":"Dagmar Marshalls Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007403","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Explore patient adherence and physician compliance to protocol guidelines during maintenance therapy, including the association with survival in adults with acute lymphoblastic leukemia (ALL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Blood counts, aminotransferase levels and prescribed 6\u2010mercaptopurine (6MP)\/methotrexate (MTX) doses were compared with the protocol guidelines to assess compliance. Non\u2010adherence to the prescribed medication was confirmed in patients with unmeasurable 6MP metabolite levels and suspected in patients with low 6MP metabolites concurrent with aminotransferase and white blood cell count within normal ranges, while potential intermittent non\u2010adherence was defined by &gt;1.9 fold fluctuating 6MP metabolites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Physicians\u2019 non\u2010compliance with insufficient dose increments of 6MP\/MTX despite white blood cell counts above the target level comprised a median of 20.1% (interquartile range 9.7\u201039.3%) of the observed time in maintenance therapy, yet no association to relapse was found (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.17). Non\u2010adherence to 6MP was confirmed in 9.8% (5 of 51 patients), suspected in an additional 9.8% (5 of 51 patients), and intermittent non\u2010adherence was suspected in 52.6% (20 of 38 patients).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although no association between non\u2010compliance and leukemic relapse was found, likely due to lack of power, increased attention to this phase of ALL therapy is indicated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ejh.13711","type":"journal-article","created":{"date-parts":[[2021,9,25]],"date-time":"2021-09-25T16:59:37Z","timestamp":1632589177000},"page":"109-117","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prevalence of non\u2010adherence and non\u2010compliance during maintenance therapy in adults with acute lymphoblastic leukemia and their associations with survival"],"prefix":"10.1111","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1225-3932","authenticated-orcid":false,"given":"Elsa R\u00e1n","family":"Kristj\u00e1nsd\u00f3ttir","sequence":"first","affiliation":[{"name":"Pediatric Oncology Research Laboratory Rigshospitalet University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Pediatrics and Adolescent Medicine Rigshospitalet University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linea Natalie","family":"Toksvang","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Research Laboratory Rigshospitalet University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Pediatrics and Adolescent Medicine Rigshospitalet University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kjeld","family":"Schmiegelow","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Research Laboratory Rigshospitalet University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Pediatrics and Adolescent Medicine Rigshospitalet University of Copenhagen  Copenhagen Denmark"},{"name":"Institute of Clinical Medicine The Faculty of Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilie Utke","family":"Rank","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Research Laboratory Rigshospitalet University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Hematology Rigshospitalet University of Copenhagen  Copenhagen 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