Treatment Name: POMP (6-Mercaptopurine + Vincristine + Methotrexate + Prednisone)
POMP (6-Mercaptopurine + Vincristine + Methotrexate + Prednisone) is a Treatment Regimen for Acute Lymphoid Leukemia (ALL)
How does POMP therapy work?
Each of the medications in POMP are designed to prevent leukemia or lymphoma cells from returning.
P – Purinethol (6-Mercaptopurine)
O – Oncovin® (Vincristine)
M – Methotrexate
P – Prednisone
Goals of POMP therapy:
POMP maintenance therapy is typically given after all cycles of therapy are completed. On occasion, POMP therapy may be used as the primary method of treating leukemia.
Examples of regimens that use POMP maintenance may include: HyperCVAD A, HyperCVAD B. POMP is commonly given to keep the disease in remission and increase the chance of achieving a cure.
How is POMP maintenance therapy for ALL taken?
- Vincristine intravenous (I.V.) infusion given over 15 minutes once monthly
- Methotrexate oral tablets by mouth once weekly
- Take on the same day of the week every week. Do not alternate days.
- Your dose will depend on your weight. On average, the number of tablets that need to be taken are typically between 12 and 20 tabs per dose
- 6-Mercaptopurine 50 mg oral tablet by mouth three times a day (at least one hour after evening meal) every day
- 6-Mercaptopurine may also be prescribed to be taken by mouth once daily (at least one hour after evening meal) every day. If prescribed this way, different amounts of tablets may need to be taken on certain days of the week so double check the prescribed daily dose each day before taking mercaptopurine. Be sure to ask a pharmacist for help with this.
- Prednisone 200 mg (four 50 mg tablets) by mouth once daily for 5 consecutive days once per month
Estimated total infusion time for POMP treatment:
- The vincristine infusion appointment may take up to 1 hour for Day 1 of each Cycle
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
Vincristine is usually given in an outpatient infusion center, allowing the person to go home afterwards. Methotrexate, 6-mercaptopurine, and prednisone are usually taken at home. 6-Mercaptopurine must be filled at a retail pharmacy. Not all pharmacies carry this medicine so it is best to call ahead to ensure it is in stock before going there in person.
POMP therapy is given continuously for up to 2 or 3 years, if well tolerated.
Click here for common POMP maintenance therapy starting doses.
What are the most common side effects from POMP therapy for ALL?
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported serious (grade 3 or 4) side effects of POMP therapy are shown here:
- Neutropenic fever (17%)
- Infection (16%)
- Increased blood sugar (12%)
- Numbness or tingling in fingers or toes (9%)
- Mouth sores (3%)
- Fatigue (3%)
- Increased blood triglycerides (2%)
- Blood clot (1%)
- Inflammation of the pancreas (1%)
- Bleeding (1%)
On average, 1% of patients discontinue treatment due to unacceptable side effects.
Watch videos on common POMP maintenance therapy side effects below
How often is monitoring with POMP therapy needed?
Labs (blood tests) may be checked before each cycle or more often at the discretion of your doctor. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
How often is imaging needed?
Imaging is not typically needed during POMP therapy, but may be checked if there are concerns for side effects. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans.
How might blood test results/imaging affect POMP treatment?
Depending upon the results, your doctor may advise to continue POMP as planned, reduce the dose of one or more of the medications in POMP, delay treatment until the side effect goes away, or discontinue therapy. To prevent infection, doses of 6-mercaptopurine or methotrexate may be delayed or reduced during periods of neutropenia (low white blood cell count).
What are the 6 most important things to know about POMP when receiving treatment?
- Continuous exposure to 6-mercaptopurine (6-MP), rather than frequent stopping and restarting, has been shown to have better anti-leukemia effect. If 6-MP is causing side effects to the point where it is difficult to take, talk with your doctor to see if reducing the dose may be safe, yet still effective
- Unless your doctor specifically tells you it is okay, you should NOT take allopurinol while taking 6-MP due to a drug interaction between these two medicines. If taken together, the allopurinol could lead to an unsafe build up of 6-MP in your body
- Omeprazole (Prilosec®), or a similar medications may be given to prevent ulcers from prednisone, however it is best not to take omeprazole on the days that methotrexate is given as it could make the methotrexate more toxic. Famotidine (Pepcid®) is usually considered a safe alternative. Check with your doctor or pharmacist first before taking famotidine to make sure it is safe.
- Patients may differ in the amount and activity of an enzyme they have that metabolizes 6-mercaptopurine, called TPMT. In some cases, genetic testing for TPMT may recommended before or during treatment with 6-mercaptopurine to test for low levels of this enzyme that could lead to increased side effects
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for ALL. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for POMP (6-Mercaptopurine + Vincristine + Methotrexate + Prednisone), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for POMP (6-Mercaptopurine + Vincristine + Methotrexate + Prednisone). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as POMP (6-Mercaptopurine + Vincristine + Methotrexate + Prednisone) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with POMP (6-Mercaptopurine + Vincristine + Methotrexate + Prednisone)