How is pediatric acute lymphoblastic leukemia (ALL) treated in patients with Down syndrome?

Updated: Jan 03, 2019
  • Author: Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Patients with Down Syndrome and ALL (DS-ALL) constitute only 2-3% of all patients diagnosed with ALL, but are highly vulnerable to toxicity from the chemotherapy agents used as well as infection. [22]

Methotrexate is linked to systemic toxicity and neurotoxicity and patients are usually treated on a modified ALL protocol with omission of high-dose methotrexate, leucovorin rescue after intrathecal methotrexate, and decreased exposure to dexamethasone and vincristine.

Death from infection is a significant risk, and patients with DS-ALL are kept inpatient during the induction phase, febrile patients receive early antibiotics (or antifungals as needed), and serum IgG levels are carefully monitored throughout the course of treatment with IVIG infused as needed.


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