Nav: Home

Children with Down syndrome and ALL fare as well as others treated on DFCI ALL protocols

December 05, 2016

SAN DIEGO, CA - Despite an elevated risk of toxicity from chemotherapy, children with Down syndrome and acute lymphoblastic leukemia (ALL) did not experience higher rates of relapse or treatment-related mortality compared with other children treated on Dana-Farber Cancer Institute ALL Consortium Protocols, according to research presented at the 58th annual meeting of the American Society of Hematology, December 5, 2016.

"Without dose reductions or modifications, the Down syndrome patients did just as well as the non-Down syndrome patients," said Lewis B. Silverman, MD, senior author of the abstract and clinical director of the Hematologic Malignancy Center at Dana-Farber/Boston Children's Cancer and Blood Disorders Center. "They were able to tolerate full-dose chemotherapy based on their risk group and did well despite biologic differences in their disease compared with other children's disease."

Children with Down syndrome are at increased risk for developing ALL, but the optimal therapy for this group of patients has not been established. Silverman notes that previous studies have shown that children with Down syndrome have an increased risk of complications of treatment. Some studies have also reported that they have higher rates of relapse and/or treatment-related mortality, resulting in lower rates of long-term cure. While the Dana-Farber protocol has never modified treatment for children with Down syndrome, Silverman added, other protocols have made dose-adjustments to minimize side effects.

"There has been controversy in the field regarding how Down syndrome children do in terms of their prognosis compared with children who don't have Down syndrome," Silverman said. "We found that with our particular treatment approach, we're not running into problems that others have reported."

Researchers studied 1286 diagnosed children and adolescents with ALL treated on the Dana-Farber Consortium protocols between 2000 and 2011 at 11 institutions in the United States, Canada, and Puerto Rico. Of these patients, 38 (3 percent) had Down syndrome. Among the findings:
  • There was no difference in the rate at which children achieved complete remission after the first month of treatment (100 percent of children with DS vs 95.2 percent without).

  • There were no treatment-related deaths among the DS patients.

  • With a median follow-up of 6.2 years, there was no statistically significant difference in five-year rates of event-free survival (90.7 percent vs 83.7 percent), disease-free survival (90.7 percent vs 87.4 percent), or overall survival 91.8 percent vs 91.4 percent).

  • Patients with Down syndrome suffered more treatment-related mucositis (mouth sores) (52 percent vs 12 percent), clots or bleeding (18.4 percent vs 8.2 percent), seizure (15.3 percent vs 4.7 percent), and infection (55.3 percent vs 41.3 percent).
As has been reported in other studies, researchers found that the Down syndrome patients were less likely than other patients to present with T-cell ALL (none in the DS group vs 11.7 percent in non-DS patients) and high hyperdiploidy (8.8 percent vs 25.1 percent). The former is considered a higher-risk form of ALL, while the latter is associated with a more favorable prognosis, Silverman said.

"The target toxicities that one needs to think about are infections and mucositis," Silverman said. "With supportive care to try to prevent these complications, our overall recommendation is that you can treat children with Down syndrome the same as other children with ALL."
-end-
Uma H. Athale, MD, MSc, of McMaster Children's Hospital, in Hamilton, Ontario, Canada, is lead author of the abstract.

Dana-Farber/Boston Children's Cancer and Blood Disorders Center - the nation's top pediatric cancer center, according to U.S. News & World Report - brings together two internationally known research and teaching institutions that have provided comprehensive care for pediatric oncology and hematology patients since 1947. The Harvard Medical School affiliates share a clinical staff that delivers inpatient care at Boston Children's Hospital and most outpatient care at Dana-Farber Cancer Institute.

Dana-Farber Cancer Institute

Related Cancer Articles:

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
Health indicators for newborns of breast cancer survivors may vary by cancer type
In a study published in the International Journal of Cancer, researchers from the UNC Lineberger Comprehensive Cancer Center analyzed health indicators for children born to young breast cancer survivors in North Carolina.
Few women with history of breast cancer and ovarian cancer take a recommended genetic test
More than 80 percent of women living with a history of breast or ovarian cancer at high-risk of having a gene mutation have never taken the test that can detect it.
More Cancer News and Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Climate Mindset
In the past few months, human beings have come together to fight a global threat. This hour, TED speakers explore how our response can be the catalyst to fight another global crisis: climate change. Guests include political strategist Tom Rivett-Carnac, diplomat Christiana Figueres, climate justice activist Xiye Bastida, and writer, illustrator, and artist Oliver Jeffers.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Speedy Beet
There are few musical moments more well-worn than the first four notes of Beethoven's Fifth Symphony. But in this short, we find out that Beethoven might have made a last-ditch effort to keep his music from ever feeling familiar, to keep pushing his listeners to a kind of psychological limit. Big thanks to our Brooklyn Philharmonic musicians: Deborah Buck and Suzy Perelman on violin, Arash Amini on cello, and Ah Ling Neu on viola. And check out The First Four Notes, Matthew Guerrieri's book on Beethoven's Fifth. Support Radiolab today at Radiolab.org/donate.