NEW YORK (Reuters Health) - It's well known that the genetic abnormality that causes Down's syndrome also puts these children at increased risk for leukemia. Now comes word that leukemia is also harder to treat successfully in kids with Down's syndrome than in other children.
"The take-home message is that ALL (acute lymphoblastic leukemia) is curable in Down's syndrome children, but to achieve this, the child has to be cared for in very skilled centers," Dr. Maurizio Arico from Children Hospital AOU Meyer, Florence, Italy told Reuters Health.
Arico and his colleagues reviewed the treatment outcome of children with ALL treated between 1982 and 2004 in six leukemia trials. The trial participants included 6237 ALL patients without Down's syndrome and 120 ALL patients who did have this syndrome.
Compared with other ALL patients, those with Down's syndrome were more often girls and older than 10 years, the investigators report in the medical journal Cancer.
During the treatment phase designed to induce remission, death occurred more often in Down syndrome patients than in those without Down syndrome (4.2 vs 2.4 percent, respectively), the researchers note. However, only one of the surviving Down's syndrome patients failed to achieve complete remission, a proportion similar to that for other patients.
The probability of surviving for 10 years without relapse or other setbacks was significantly lower among Down's syndrome patients (55.8 percent) than among non-Down's syndrome patients (69.7 percent), the investigators report.
The situation did improved over time, however. Overall survival was higher in Down's syndrome patients diagnosed after 1995 than in those diagnosed before 1995, but still lower than that seen in patients without the syndrome.
Children with Down's syndrome are immune-deficient, Arico noted. "We have to be very careful not to make additional immune depression induced by chemotherapy, simply too much for them to survive infections."
His group constantly monitors outcomes of patients with Down syndrome and ALL "treated worldwide by different groups or large institutions," Arico added. This may "provide additional insights" for treating these patients.
SOURCE: Cancer, August 1, 2008.
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Date last updated: 05 September 2008 |