{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:10:15Z","timestamp":1790122215471,"version":"4.0.1"},"reference-count":26,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"15","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2017,5,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> Children with acute lymphoblastic leukemia (ALL) are generally instructed to take mercaptopurine (6-MP) in the evening and without food or dairy products. This study examines the association between 6-MP ingestion habits and 6-MP adherence, red cell thioguanine nucleotide (TGN) levels, and risk of relapse in children with TMPT wild-type genotype. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Participants included 441 children with ALL receiving oral 6-MP for maintenance. Adherence was monitored over 48,086 patient-days using the Medication Event Monitoring System; nonadherence was defined as adherence rate &lt; 95%. 6-MP ingestion habits examined included: takes 6-MP with versus never with food, takes 6-MP with versus never with dairy, and takes 6-MP in the evening versus morning versus varying times. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Median age at study was 6 years (range, 2 to 20 years); 43.8% were nonadherent. Certain 6-MP ingestion habits were associated with nonadherence (taking 6-MP with dairy [odds ratio (OR), 1.9; 95% CI, 1.3 to 2.9; P = .003] and at varying times [OR, 3.4; 95% CI, 1.8 to 6.3; P = .0001]). After adjusting for adherence and other prognosticators, there was no association between 6-MP ingestion habits and relapse risk (6-MP with food: hazard ratio [HR], 0.7; 95% CI, 0.3 to 1.9; P = .5; with dairy: HR, 0.3; 95% CI, 0.07 to 1.5; P = .2; taken in evening\/night: HR, 1.1; 95% CI, 0.2 to 7.8; P = .9; at varying times: HR, 0.3; 95% CI, 0.04 to 2.7; P = .3). Among adherent patients, there was no association between red cell TGN levels and taking 6-MP with food versus without (206.1 \u00b1 107.1 v 220.6 \u00b1 121.6; P = .5), with dairy versus without (220.1 \u00b1 87.8 v 216.3 \u00b1 121.3; P =.7), or in the evening\/night versus morning\/midday versus varying times (218.8 \u00b1 119.7 v 195.5 \u00b1 82.3 v 174.8 \u00b1 93.4; P = .6). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Commonly practiced restrictions surrounding 6-MP ingestion might not influence outcome but may hinder adherence. Future recommendations regarding 6-MP intake during maintenance therapy for childhood ALL should aim to simplify administration. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2016.71.7579","type":"journal-article","created":{"date-parts":[[2017,3,24]],"date-time":"2017-03-24T19:58:14Z","timestamp":1490385494000},"page":"1730-1736","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":37,"title":["Mercaptopurine Ingestion Habits, Red Cell Thioguanine Nucleotide Levels, and Relapse Risk in Children With Acute Lymphoblastic Leukemia: A Report From the Children\u2019s Oncology Group Study AALL03N1"],"prefix":"10.1200","volume":"35","author":[{"given":"Wendy","family":"Landier","sequence":"first","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. Termuhlen, Children\u2019s Hospital Los Angeles, Los Angeles; F. Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Hageman","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. Termuhlen, Children\u2019s Hospital Los Angeles, Los Angeles; F. Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Chen","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. Termuhlen, Children\u2019s Hospital Los Angeles, Los Angeles; F. Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Kornegay","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. Termuhlen, Children\u2019s Hospital Los Angeles, Los Angeles; F. Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Evans","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. Termuhlen, Children\u2019s Hospital Los Angeles, Los Angeles; F. Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce C.","family":"Bostrom","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. 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Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Dickens","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. Termuhlen, Children\u2019s Hospital Los Angeles, Los Angeles; F. Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne L.","family":"Angiolillo","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. Termuhlen, Children\u2019s Hospital Los Angeles, Los Angeles; F. Lennie..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen","family":"Lew","sequence":"additional","affiliation":[{"name":"Wendy Landier, Lindsey Hageman, Yanjun Chen, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL; Nancy Kornegay, William E. Evans, and Mary V. Relling, St. Jude Children\u2019s Research Hospital, Memphis, TN; Bruce C. Bostrom, Children\u2019s Hospitals and Clinics of Minnesota, Minneapolis, MN; Jacqueline Casillas, David Geffen School of Medicine at University of California Los Angeles, Los Angeles; Leo Mascarenhas and Amanda M. 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