Abstract
We report a retrospective analysis of 11 children with Down syndrome (DS) treated by SCT in eight German/Austrian SCT centres. Indications for transplantation were acute lymphoblastic leukaemia (N=8) and acute myeloid leukaemia (N=3). A reduced intensity conditioning (RIC) containing 2 Gy TBI was given to two patients, another five received a myeloablative regimen with 12 Gy TBI. Treosulphan or busulphan was used in the remaining four children. Four of eleven (36%) patients are alive. All of them were treated with a myeloablative regimen. One of the four surviving children relapsed 9 months after SCT and is currently receiving palliative outpatient treatment. The main cause of death was relapse (5/11). Two children died of regimen-related toxicity (RRT), one from severe exfoliative dermatitis and multiorgan failure after a treosulphan-containing regimen, the other from GvHD-related infections after RIC. Acute GvHD of the skin was observed in 10 of 10 evaluable patients, and chronic GvHD in 4 of 8. Our data show that DS patients can tolerate commonly used, fully myeloablative preparative regimens. The major cause of death is relapse rather than RRT resulting in an event-free survival of 18% and over all survival of 36%.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Lange B . The management of neoplastic disorders of haematopoiesis in children with Down's syndrome. Br J Haematol 2000; 110: 512–524.
Krivit W, Good RA . The simultaneous occurrence of leukemia, mongolism; report of four cases. AMA J Dis Child 1956; 91: 218–222.
Dordelmann M, Schrappe M, Reiter A, Zimmermann M, Graf N, Schott G et al. Down's syndrome in childhood acute lymphoblastic leukemia: clinical characteristics, treatment outcome in four consecutive BFM trials. Berlin-Frankfurt-Munster Group. Leukemia 1998; 12: 645–651.
Whitlock JA, Sather HN, Gaynon P, Robison LL, Wells RJ, Trigg M et al. Clinical characteristics, outcome of children with Down syndrome, acute lymphoblastic leukemia: a Children's Cancer Group study. Blood 2005; 106: 4043–4049.
Lange BJ, Kobrinsky N, Barnard DR, Arthur DC, Buckley JD, Howells WB et al. Distinctive demography, biology, outcome of acute myeloid leukemia, myelodysplastic syndrome in children with Down syndrome: Children's Cancer Group Studies 2861, 2891. Blood 1998; 91: 608–615.
Creutzig U, Ritter J, Vormoor J, Ludwig WD, Niemeyer C, Reinisch I et al. Myelodysplasia, acute myelogenous leukemia in Down's syndrome. A report of 40 children of the AML-BFM Study Group. Leukemia 1996; 10: 1677–1686.
Levitt GA, Stiller CA, Chessells JM . Prognosis of Down's syndrome with acute leukaemia. Arch Dis Child 1990; 65: 212–216.
Ravindranath Y, Abella E, Krischer JP, Wiley J, Inoue S, Harris M et al. Acute myeloid leukemia (AML) in Down's syndrome is highly responsive to chemotherapy: experience on Pediatric Oncology Group AML Study 8498. Blood 1992; 80: 2210–2214.
Renson Jr EB, Forde MD . Bone marrow transplantation for acute leukemia and Down syndrome: report of a successful case and results of a national survey. J Pediatr 1989; 114: 69–72.
Rubin CM, O'Leary M, Koch PA, Nesbit Jr ME . Bone marrow transplantation for children with acute leukemia and Down syndrome. Pediatrics 1986; 78: 688–691.
Rubin CM, Mick R, Johnson FL . Bone marrow transplantation for the treatment of haematological disorders in Down's syndrome: toxicity and outcome. Bone Marrow Transplant 1996; 18: 533–540.
Goleta-Dy A, Dalla Pozza L, Shaw PJ, Stevens MM . Acute myeloid leukaemia in patients with trisomy 21 (Down syndrome) treated by bone marrow transplantation. J Paediatr Child Health 1994; 30: 275–277.
Pawlowska AB, Davies SM, Orchard PJ, Wagner JE, Ramsay NK . Unrelated donor bone marrow transplantation for acute leukemia in patients with Down's syndrome. Bone Marrow Transplant 1996; 18: 453–455.
Hegenbart U, Niederwieser D, Sandmaier BM, Maris MB, Shizuru JA, Greinix H et al. Treatment for acute myelogenous leukemia by low-dose, total-body, irradiation-based conditioning and hematopoietic cell transplantation from related and unrelated donors. J Clin Oncol 2006; 24: 444–453.
Locatelli F, Uderzo C, Dini G, Zecca M, Arcese W, Messina C et al. Graft-versus-host disease in children: the AIEOP-BMT Group experience with cyclosporin A. Bone Marrow Transplant 1993; 12: 627–633.
Kondo M, Kojima S, Horibe K, Kato K, Matsuyama T . Risk factors for chronic graft-versus-host disease after allogeneic stem cell transplantation in children. Bone Marrow Transplant 2001; 27: 727–730.
Zecca M, Prete A, Rondelli R, Lanino E, Balduzzi A, Messina C et al. Chronic graft-versus-host disease in children: incidence, risk factors, and impact on outcome. Blood 2002; 100: 1192–1200.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Meissner, B., Borkhardt, A., Dilloo, D. et al. Relapse, not regimen-related toxicity, was the major cause of treatment failure in 11 children with Down syndrome undergoing haematopoietic stem cell transplantation for acute leukaemia. Bone Marrow Transplant 40, 945–949 (2007). https://doi.org/10.1038/sj.bmt.1705844
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705844
Keywords
This article is cited by
-
Hematopoietic Stem Cell Transplantation in Pediatric Acute Lymphoblastic Leukemia
Current Hematologic Malignancy Reports (2019)
-
Hematological disorders and leukemia in children with Down syndrome
European Journal of Pediatrics (2012)