PDF herunterladen
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(06): 841-845
DOI: 10.4103/ijmpo.ijmpo_175_20
Original Article

Treating acute myeloid leukemia among children with down syndrome

Rajan Kapoor
Department of Medicine and Hematology, Command Hospital, Kolkata, West Bengal, India
,
Karthik Ram Mohan
Department of Pediatrics, Command Hospital, Kolkata, West Bengal, India
,
Shuvendu Roy
Department of Pediatrics, Command Hospital, Kolkata, West Bengal, India
,
Suman Kumar Pramanik
Department of Medicine and Hematology, Army Hospital (Research and Referral), New Delhi, India
,
Sanjeev Khera
Department of Pediatrics, Army Hospital (Research and Referral), New Delhi, India
,
A K Simalti
Pediatric Intensivist, Army Hospital (Research and Referral), New Delhi, India
› Institutsangaben Financial support and sponsorship Nil.
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Background: Down Syndrome (DS) children with acute myeloid leukemia (AML) have unique differences in clinical features, epidemiologic nature, and biologic patterns of disease compared with AML in children without DS. Aims and Objective: AML in DS children should be considered distinct disorder from AML in Non DS population and treatment needs to be customized for this population. In this retrospective study spanning from 2014 to 2019 we present our experience of managing leukemia in children with DS. Materials and Methods: From 2014 and 2019, 72 children aged below 18 years were managed at our institute with acute myeloid leukemia (AML). Out of these 72 children with AML, 7 children were with DS which was confirmed by karyotyping. Majority of these children had M7 while M2 and M4 subtypes were seen in one child each. On conventional karyotyping in addition to trisomy 21 additional cytogenetic abnormalities were seen in 4 patients. Two children had trisomy 8. One child had deletion of 11 chromosomes and one had translocation between 8 and 21 chromosomes. Results: All 7 children were administered intensive chemotherapy with curative intent after informed parental consent. All 7 children achieved complete remission. Four out of 7 children had complications related to severe neutropenia. Conclusion: All patients of DS with AML should be offered chemotherapy with curative intent. Endeavour should be to give less aggressive chemotherapy protocol to bring down treatment related mortality.

Keywords

Acute myeloid leukemia - curative intent - Down syndrome


Publikationsverlauf

Eingereicht: 20. April 2020

Angenommen: 19. August 2020

Artikel online veröffentlicht:
14. Mai 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Amayreh A, Al QaqaK, Ali AH, Issa K. Clinical and cytogenetic profile of down syndrome at king hussein medical centre. JRMS 2012; 19: 14-8
    Google Scholar
  • 2 Mitelman F, Heim S, Mandahl N. Trisomy 21 in neoplastic cells. Am J Med Genet Suppl 1990; 7: 262-6
    Google Scholar
  • 3 Falini B, Tiacci E, Martelli MP, Ascani S, Pileri SA. New classification of acute myeloid leukemia and precursor-related neoplasms: Changes and unsolved issues. Discov Med 2010; 10: 281-92
    PubMedGoogle Scholar
  • 4 Lange B. The management of neoplastic disorders of haematopoiesis in children with Down'ssyndrome. Br J Haematol 2000; 110: 512-24
    CrossrefPubMedGoogle Scholar
  • 5 Hama A, Yagasaki H, Takahashi Y, Nishio N, Muramatsu H, Yoshida N. et al. Acute megakaryoblasticleukaemia (AMkL) in children: Acomparison of AMkL with and without Down syndrome. Br J Haematol 2008; 140: 552-61
    CrossrefPubMedGoogle Scholar
  • 6 Abildgaard L, Ellebaek K, Gustafsson G, Abildgaard L, Ellebaek E, Gustafsson G. et al Optimal treatment intensity in children with downsyndrome and myeloid leukaemia: Data from 56 children treated on NOPHO-AML protocols and areview of the literature. Ann Hematol 2006; 85: 275-80
    CrossrefPubMedGoogle Scholar
  • 7 Taga T, Shimomura Y, Horikoshi Y, Ogawa A, Itoh M, Okada M. et al. Continuous and high-dose cytarabine combinedchemotherapy in children with down syndrome and acute myeloid leukemia: Report from theJapanese children's cancer and leukemia study group (JCCLSG) AML 9805 down study. Pediatr Blood Cancer 2011; 57: 36-40
    CrossrefPubMedGoogle Scholar
  • 8 Wechsler J, Greene M, McDevitt MA, Anastasi J, Karp JE, Le BeauMM. et al. Acquired mutations in GATA1 in the megakaryoblastic leukemia of Down syndrome. Nat Genet 2002; 32: 148-52
    CrossrefPubMedGoogle Scholar
  • 9 Linabery AM, Ross JA. Trends in childhood cancer incidence in the U.S. (1992-2004). Cancer 2008; 112: 416-32
    CrossrefPubMedGoogle Scholar
  • 10 Howlader N, Howlader A, Krapcho MS, Noone AM, Neyman N, Aminou R. et al. SEER cancer statistics review, 1975-2009 (vintage 2009 populations).
  • 11 Arora RS, Arora B. Acute leukemia in children: A review of the current Indian data. South Asian J Cancer 2016; 5: 155-60
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Radhakrishnan V, Thampy C, Ganesan P, Rajendranath R, Ganesan TS, Rajalekshmy KR. et al. Acute myeloid leukemia in children: Experience from tertiary cancer centre in India. Indian J Hematol Blood Transfus 2016; 32: 257-61
    CrossrefPubMedGoogle Scholar
  • 13 Kulkarni KP, Marwaha RK. Childhood acute myeloid leukemia: An Indian perspective. Pediatr Hematol Oncol 2011; 28: 257-68
    CrossrefPubMedGoogle Scholar
  • 14 Seth R, Pathak N, Singh A, Chopra A, Kumar R, Kalaivani M. Pediatric acute myeloid leukemia: Improved survival rates in India. Indian J Pediatr 2017; 84: 166-7
    CrossrefPubMedGoogle Scholar
  • 15 Arora RS, Pizer B, Eden T. Understanding refusal and abandonment in the treatment of childhood cancer. Indian Pediatr 2010; 47: 1005-10
    CrossrefPubMedGoogle Scholar
  • 16 Kapoor R, Mathews V, Sengar M, Bhurani D, Radhakrishnan V, Philip C. et al. Hematological cancer consortium: Multi-center acute myeloid leukemia registry data from India. Blood 2018; 132 (Suppl 1): 4006
    CrossrefGoogle Scholar
  • 17 Caldwell JT, Ge Y, Taub JW. Prognosis and management of acute myeloid leukemia in patients with Down syndrome. Expert Rev Hematol 2014; 7: 831-40
    CrossrefPubMedGoogle Scholar
  • 18 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: 2210-4
    CrossrefPubMedGoogle Scholar
  • 19 Sorrell AD, Alonzo TA, Hilden JM, Gerbing RB, Loew TW, Hathaway L. et al. Favorable survival maintained in children who have myeloid leukemia associated with down syndrome using reduced-dose chemotherapy on children's oncology group trial A2971: A report from the children's oncology group. Cancer 2012; 118: 4806-14
    CrossrefPubMedGoogle Scholar
  • 20 Uffmann M, Rasche M, Zimmermann M, Neuhoff CV, Creutzig U, Dworzak M. et al. Therapy reduction in patients with Down syndrome and myeloid leukemia: The international ML-DS 2006 trial. Blood 2017; 129: 3314-21
    CrossrefPubMedGoogle Scholar
  • 21 Lehrnbecher T, Zimmermann M, Reinhardt T, Dworzak M, Stary J, Creutzig U. et al. Prophylactic human granulocyte colony-stimulating factor after induction therapy in Pediatric acute myeloid leukemia. Blood 2007; 109: 936-43
    CrossrefPubMedGoogle Scholar
  • 22 Lohmann DJ, Asdahl PH, Abrahamsson J, Ha SY, Jónsson ÓG, Kaspers GJL. et al Use of granulocyte colony-stimulating factor and risk of relapse in pediatric patients treated for acute myeloid leukemia according to NOPHO-AML 2004 and DB AML-01. Pediatr Blood Cancer 2019; 66: e27701
    CrossrefPubMedGoogle Scholar
  • 23 Feng X, Lan H, Ruan Y, Li C, Sarin YK. Impact on acute myeloid leukemia relapse in granulocyte colony-stimulating factor application: A meta-analysis. Hematology 2018; 23: 581-9
    CrossrefPubMedGoogle Scholar
  • 24 Gurion R, Belnik-Plitman Y, Gafter-Gvili A, Paul M, Vidal L, Ben-Bassat I. et al. Colony-stimulating factors for prevention and treatment of infectious complications in patients with acute myelogenous leukemia. Cochrane Database Syst Rev 2012; 6: CD008238
    Google Scholar
  • 25 Von Neuhoff C, Reinhardt D, Sander A, Bradtke J, Betts DR, Zemanova Z. et al. Prognostic impact of specific chromosomal aberrations in a large group of pediatric patients with acute myeloid leukemia treated uniformly according to trial AML-BFM 98. J Clin Oncol 2010; 28: 2682-9
    CrossrefPubMedGoogle Scholar
  • 26 Blink M, Zimmermann M, von Neuhoff C, Reinhardt D, Haas V, Hasle H. et al. Normal karyotype is a poor prognostic factor in myeloid leukemia of Down syndrome: A retrospective, international study. Haematologica 2014; 99: 299-307
    CrossrefPubMedGoogle Scholar