Thiopurines for the treatment of acute lymphoblastic leukemia in children: What’s old is new
Menée aux Etats-Unis auprès de 742 enfants atteints d'une leucémie lymphoblatique aiguë, cette étude de cohorte prospective évalue l'association entre un traitement à base de mercaptopurine et le risque de récidive de la maladie, en fonction de l'observance thérapeutique
The treatment of children with acute lymphoblastic leukemia (ALL) is one of the greatest success stories in the history of medicine. The 5-year overall survival rate for children with ALL has improved from approximately 10% in the 1960s to greater than 90% with contemporary treatment regimens,1- 5 with almost all children who remain in remission for more than 4 years after completion of treatment considered “cured.”5 One of the key reasons for this remarkable achievement has been the enrollment of children with ALL in successive, prospective clinical trials seeking to refine our understanding of disease biology, including clinical, genetic, and response-based prognostic factors, and to optimize the use of known effective therapies. With the exception of the recent development of highly innovative biologically targeted therapies for children with relapsed and refractory ALL (eg, CD19-directed therapy including blinatumomab and chimeric antigen receptor [CAR] T cells), modern ALL therapy remains rooted in a platform of a limited number of effective chemotherapeutic drugs that were developed and approved by the US Food and Drug Administration (FDA) many decades ago (eg, methotrexate, 1953; 6-mercaptopurine [6MP], 1953; dexamethasone, 1958; vincristine, 1963; daunomycin, 1979; asparaginase, 1994). One of the most important of these drugs is the thiopurine 6MP; it is used intermittently throughout the intensive phases of modern ALL therapy and then forms the backbone of 2 to 3 years of maintenance therapy.
JAMA Oncology , éditorial, 2014