Outcome of transplantation for acute lymphoblastic leukemia in children with Down syndrome

Pediatr Blood Cancer. 2014 Jun;61(6):1126-8. doi: 10.1002/pbc.24918. Epub 2014 Jan 4.

Abstract

We report on 27 patients with Down syndrome (DS) and acute lymphoblastic leukemia (ALL) who received allogeneic hematopoietic cell transplantation (HCT) between 2000 and 2009. Seventy-eight percent of patients received myeloablative conditioning and 52% underwent transplantation in second remission. Disease-free survival (DFS) was 24% at a median of 3 years. Post-transplant leukemic relapse was more frequent than expected for children with DS-ALL (54%) than for non-DS ALL. These data suggest leukemic relapse rather than transplant toxicity is the most important cause of treatment failure. Advancements in leukemia control are especially needed for improvement in HCT outcomes for DS-ALL.

Keywords: Down syndrome; acute lymhoblastic leukemia; hematopoietic stem cell transplantation; pediatric; relapse; trisomy 21.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Allografts
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bone Marrow Transplantation
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Cyclosporine / adverse effects
  • Cyclosporine / therapeutic use
  • Disease-Free Survival
  • Down Syndrome / complications*
  • Genetic Predisposition to Disease
  • Graft vs Host Disease / drug therapy
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infant
  • Kaplan-Meier Estimate
  • Living Donors
  • Myeloablative Agonists / adverse effects
  • Myeloablative Agonists / therapeutic use
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / genetics
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / surgery*
  • Recurrence
  • Registries
  • Remission Induction
  • Retrospective Studies
  • Salvage Therapy
  • Tacrolimus / adverse effects
  • Tacrolimus / therapeutic use
  • Transplantation Conditioning / adverse effects
  • Transplantation Conditioning / methods
  • Treatment Outcome
  • Whole-Body Irradiation / adverse effects

Substances

  • Immunosuppressive Agents
  • Myeloablative Agonists
  • Cyclosporine
  • Tacrolimus