Down's syndrome and leukemia

• Most children with Down's syndrome now live into adolescence and adulthood.
• Leukemia is from 10 to 30 times more common in these children than in the general population.
• All of the different types of Down's syndrome show a similar increased risk of Leukemia.
• This still only represents about 1 in 150 of Down's children.
• About 2% of all cases of childhood leukemia occur in children who have Down's Syndrome.
• The age distribution of leukemia in children on with Down's syndrome is the same as in the general population.

Transient Abnormal Myelopoiesis (TAM)

Transient abnormal myelopoiesis (TAM) is a condition which is almost never seen in children who do not have Down's Syndrome. In TAM, which is usually seen at or soon after birth the blood and bone marrow show changes which appear typical of Leukemia. The blood and bone marrow of children with TAM return to normal without treatment. In about 20 to 30% of cases with these blood and bone marrow changes leukemia will develop, this is usually acute myeloid leukemia (AML). There is no test which can distinguish between TAM and leukemia and the diagnosis of TAM can only be made after the condition has spontaneously cleared up. It is very likely that the same mechanism(s) explain both the excess number of cases of leukemia seen in Down's syndrome and TAM. It is probable that all these cases commence in a similar way. For some unexplained reason, possibly a further genetic abnormality, in some children the condition progresses and becomes full-blown leukemia while in other children it resolves.

Types of Leukemia seen in Down's Syndrome

Both acute lymphoblastic leukemia and acute myeloid leukemia are seen in children with Down's Syndrome.

Most patients who have acute Iymphoblastic leukemia (ALL) and Down's Syndrome have the common ALL (cALL) sub.type. The leukemia cells from these children Iess frequently show chromosome changes of a type regarded as being "poor risk" than in other children with ALL. That is to say that they rarely have changes which would predict a poor response to standard treatment. Children with Down's syndrome and ALL usually have a good response to treatment and a good chance of a cure. It is very important that parents should discuss this with their child's specialist, who is the only person who can read more

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