Acute lymphoblastic leukemia (ALL) studies across the globe haveshown that delivering optimal maintenance therapy (MT) is crucial toachieve better treatment outcomes[1]. Delivering optimal MTincludes prescribing maximum tolerated doses of 6-mercaptopurine (6MP)and methotraxate (MTX) based on patient’s blood counts (absoluteneutrophil count (ANC), platelet count (PLT) and hemoglobin (HB)). Inview of this, theallMT package was created to analyse andvisualize the MT data (ANC/PLT/HB/6MP/MTX) for single patient or a givencohort at any center1. The package was developedconsidering the ICiCLe-ALL-14 protocol[3] as default. It can be used toanalyze data from centers with different MT protocols where in the userwill need to alter the function defined ipnut argument/parameters.
Using this package the user may:
Convert maintenance sheets (Tata Medical Center Kolkata, Indiaformat or user dependent) into a cleaner, single csv with longitudinaldata for each patient.
Analyze MT[2]
At an individual patient level
To track patient’s MT progression during or aftertherapy.
To track patient’s cycle-by-cycle MT progression during or afterthe therapy using summary measure (SM) weighted mean (6MP*MTX) vsweighted mean ANC parameters in a scatterplot.
Asses hematological toxicities - neutropenia, thrombocytopeniaand anemia during MT.
Evaluate median time to first 6MP dose increase for thecohort.
Evaluate real time dosing decisions (stop, reduce or increase) bythe physicians during MT based on MT dosing guidelines[2]
At cohort level
SM plot to analyze MT for a given cohort defined by the user. SMis evaluated for each patient and plotted together to represent theentire cohort.
Compare SM for two or more cohort defined by the user to evaluateMT practice. Cohort comparisons can include clinical interventions,year-wise evolution, patients treated by two different set ofphysicians, or as user see it fit.
Asses hematological toxicities - neutropenia, thrombocytopeniaand anemia during MT.
Plot depicting median time to first 6MP dose increase for thecohort.
Evaluate real time dosing decisions (stop, reduce or increase) bythe physicians during MT based on MT dosing guidelines[2]
You can install the development version of allMT fromGitHub with:
# install.packages("devtools")devtools::install_github("tmungle/allMT")The anonymized clinical data set refers to patients treated on theICiCLe-ALL-14 treatment protocol at the Tata Medical Center Kolkata(institutional review board approval EC/TMC/12/13 for the treatmentprotocol). Funding support for the ICiCLe-ALL-14 clinical study(Clinical Trials Registry-India reference CTRI/2015/12/006434) wasprovided by the National Cancer Grid (2016/001; 2016-) and the IndianCouncil of Medical Research (79/159/2015/NCD-III; 2017-19)
By abiding toContributorCode of Conduct, contribution toallMT in any form bugfixes/code modification/new code development is welcomed.
The work was initiated as part ofTushar Mungle’s PhD work at IIT Kharagpur[2] and then continued at TTCRC,Tata Medical Center, Kolkata.↩︎