Down syndrome does not impact treatment outcomes among children with ALL


An analysis of children with acute lymphoblastic leukemia showed those with Down syndrome achieved comparable survival outcomes and experienced similar toxicity as children without Down syndrome, according to findings presented at the ASH Annual Meeting and Exposition.

Uma H. Athale, MD, MSc, of the division of hematology/oncology at McMaster Children’s Hospital and the department of pediatrics at McMaster University in Hamilton, Canada, and colleagues analyzed demographic, clinical and outcome data of 1,286 children with ALL who underwent treatment with Dana-Farber Cancer Institute ALL Consortium protocols between 2000 and 2011.

Thirty-eight children in the analysis had Down syndrome.

“Patients with Down syndrome ALL generally experience higher treatment-related mortality and higher-risk disease,” Athale said during a presentation. “Therapy modifications and dose reductions are common strategies for this population.”

However, there is no defined protocol for treatment modifications and dose reductions.

Athale and colleagues assessed the toxicity profile and outcomes in newly diagnosed children with ALL, comparing results of those with Down syndrome and those without.

All children underwent identical therapy, receiving doxorubicin 60 mg/m2during remission induction, along with leucovorin and one high dose of methotrexate. However, children with Down syndrome had the option to receive three doses of leucovorin after intrathecal methotrexate.

Mucositis occurred in 52 of children with Down syndrome and 12% of those without (P < .001).

Researchers reported higher rates of mucositis (52% vs. 12%; P < .001) and seizures (15.8% vs. 4.7%; P = .01) among children with Down syndrome.

A higher percentage of children with Down syndrome developed bacterial and fungal infections (55.3% vs. 41%), but the difference was not statistically significant.

Other comorbidities appeared comparable between the two groups.

Researchers reported complete response rates of 100% among those with Down syndrome and 95% among those without.

Results revealed higher rates of 5-year OS (97.1% vs. 91%) and 5-year EFS (91% vs. 82%) among children with Down syndrome. There was no significant difference in the proportion of patients in each group with low end-of-induction minimal residual disease.

“Down syndrome ALL patients treated on Dana-Farber Cancer Institute ALL Consortium protocols achieved similar OS and EFS compared with non-Down syndrome ALL patients,” Athale said. “There were low rates of toxicity for [both groups]. We also observed low rates of relapse. These observations support the approach of a unified therapy protocol for Down syndrome ALL and non-Down syndrome ALL patients.” – by Rob Volansky

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