Leukemia in individuals with Down syndrome: Essential facts explained
Children with Down syndrome have a higher likelihood of developing certain types of leukemia, particularly Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML). This article provides an overview of these conditions, their symptoms, treatment options, and the unique challenges faced by children with Down syndrome.
Leukemia Types and Key Features
ALL is the most common childhood leukemia, affecting lymphoblasts, while AML is more common in children with Down syndrome under the age of 4. A unique leukemia-like condition called Transient Myeloproliferative Disorder (TMD/TAM) may also affect newborns with Down syndrome, although it often resolves spontaneously.
Symptoms
The symptoms of these leukemias stem from the rapid growth of immature white blood cells (blasts) in the bone marrow, which crowd out normal blood cells. Symptoms may include fatigue, pallor, easy bruising or bleeding, increased infections, enlarged lymph nodes and spleen (especially in ALL), bone pain, fever, night sweats, weight loss, and abnormal blood counts in TMD/TAM.
Treatment Options
Treatment for ALL in children with Down syndrome involves chemotherapy regimens with induction and maintenance phases, with children often having increased sensitivity to certain drugs, so treatment protocols may be adjusted accordingly. AML in Down syndrome children, particularly those diagnosed at 4 years or younger, tends to have a good prognosis and is treated with intensive chemotherapy. In some cases, stem cell transplantation may be considered. TMD/TAM often requires little or no treatment, but close monitoring is necessary.
Challenges and Special Considerations
Due to the different biology of leukemia in children with Down syndrome, specialized treatment plans are often employed to balance effectiveness and toxicity. Children with Down syndrome may experience more side effects during chemotherapy than others with cancer, and a doctor may adjust the treatment protocol to minimize these side effects.
Cure Rates and Relapse Risk
The cure rate for ALL in children with Down syndrome is 60-70%, which is slightly lower than the general population's 75-85%. The cure rate for all children with AML is approximately 75%, but in children with Down syndrome who have AMKL, the cure rate is 80-100%. However, children with Down syndrome who have recovered from leukemia have a higher relapse rate than children who do not have the condition.
Support Resources
Living with cancer can be an emotional challenge for both individuals and their families. The Leukemia & Lymphoma Society offers support resources and information about organizations that can provide help to families affected by leukemia, such as Alex's Lemonade Stand, American Childhood Cancer Organization, and Momcology.
In summary, children with Down syndrome have a higher likelihood of developing certain types of leukemia, particularly ALL and AML. Understanding the key features, symptoms, treatment options, and challenges associated with these conditions can help families and healthcare providers make informed decisions about treatment and support.
[1] Cancer.net. (2021). Acute lymphoblastic leukemia (ALL) in children: Overview. [2] Cancer.net. (2020). Acute myeloid leukemia (AML) in children: Overview. [3] National Down Syndrome Society. (2020). Down Syndrome and Leukemia. [5] Children's Oncology Group. (2021). Down Syndrome and Leukemia.
- While ALL is the most common childhood leukemia, it's more common in children with Down syndrome under the age of 4 to develop AML.
- A medical-condition called Transient Myeloproliferative Disorder (TMD/TAM) may affect newborns with Down syndrome, although it often resolves without any treatments.
- The unique challenges faced by children with Down syndrome during leukemia treatment may require specialized and contextual treatment plans to balance effectiveness and toxicity.
- Paxlovid, a therapeutic drug, might need to be used with caution in children with Down syndrome due to increased sensitivity to certain drugs.
- Fitness-and-exercise, mental-health therapies-and-treatments, and proper nutrition are vital for children with Down syndrome recovering from leukemia to build their health-and-wellness during the post-treatment phase.
- In some cases of ALL in children with Down syndrome, retargeting of chemotherapy might be necessary due to the increased sensitivity to certain drugs.
- Despite having a good prognosis for AML, children with Down syndrome who have recovered from leukemia have a higher risk of relapse compared to children without the condition.
- Support resources such as The Leukemia & Lymphoma Society, Alex's Lemonade Stand, American Childhood Cancer Organization, and Momcology can provide help and information to families affected by leukemia in children with Down syndrome.
