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• Posted November 1, 2023

Children With Down Syndrome More Vulnerable to Leukemia

While new treatments for leukemia have improved outcomes for many patients, children with Down syndrome have not benefited as much.

These young people are at increased risk for acute lymphoblastic leukemia (ALL) and have higher rates of relapse and treatment-related harm.

A new review looked at more contemporary therapies through clinical trial results to see what impact those may have had.

In the study led by Baylor College of Medicine and Texas Children's Cancer Center, researchers reviewed Children's Oncology Group trial results from 2003 to 2019.

The investigators found that children with Down syndrome and ALL continue to have higher rates of relapse and treatment-related death compared to children without Down syndrome.

The study authors said use of less toxic therapies is needed to improve outcomes.

The study included more than 740 patients with Down syndrome and ALL, and more than 20,000 ALL patients who did not have Down syndrome.

The five-year survival for patients with Down syndrome was about 7% lower than for other patients, the findings showed.

While modern therapies have lowered the risk of relapse in patients with Down syndrome, the risk of treatment-related death remains high, according to the report published online Oct. 27 in the Journal of Clinical Oncology.

“Outcomes in childhood ALL have improved in large part because treatment has intensified, which prevents relapse,” corresponding author Dr. Karen Rabin, a professor of pediatric hematology and oncology, said in a Baylor news release.

“However, children with Down syndrome aren't benefiting as much as other children because they experience a higher risk of life-threatening infection,” Rabin added.

Low white blood cell counts during treatment make patients more vulnerable to infection.

In addition, kids who have Down syndrome also have a higher frequency of mouth sores, higher blood sugar levels and seizures related to the chemotherapy.

“Increased use of immunotherapeutic strategies, which are less toxic than chemotherapy, has been a revolutionary advance for all children with ALL, and children with Down syndrome especially stand to gain from this less toxic approach to treatment,” Rabin concluded.

More information

The Leukemia and Lymphoma Society has more on acute lymphoblastic leukemia.

SOURCE: Baylor College of Medicine, news release, Oct. 30, 2023