Acute myoloid leukemia is also seen in higher than normal rate in Down's Syndrome and the disease is typically seen at an earlier age than in other children with AML. AML in Down’s Syndromes is usually of the FAB M7 sub-type which affects mainly the platelet producing cells in the bone marrow. There is often a long period before this diagnosis is made when the blood count is moderately abnormal there is no clear evidence of Leukemia.
When a very young child has changes which would usually suggest Leukemia it is important to rule out TAM in case any unnecessary treatment is given. This may be a very difficult period for parents and close liaison with the hospital, preferably with one named nurse or doctor, may help.
In some of the children with Down's syndrome who eventually develop acute myeloid Leukemia, this is proceeded by a bone marrow condition called myelodysplastic syndrome. In patients without Down's syndrome, leukemia which develops after myelodysplastic syndrome (secondary leukemia) tends to respond poorly to standard treatment in Down's Syndrome it appears to have no effect on response to treatment whether or not the child has previously had myelodysplastic syndrome.
Treatment
The outlook for children with Down's syndrome and ALL is as good as that for other children with ALL, and for AML the outlook is better than for other children.Many children with Down's syndrome also have heart abnormalities. There is no evidence at present to indicate whether or not this leads to an increased risk of developing cardiac toxicity when treated with anti cancer drugs. Doctors treating children with Down's syndrome will keep a particularly careful watch for any signs of heart problems.
Children with Down's syndromes are more prone to serious side-effects when treated with methotrexate. These side effects can be greatly reduced by giving doses of folic acid along with the methotrexate.
The treatment of Down's syndrome children with leukemia is largely the same as for other children. They do require particular careful attention to prevention of infection as they are more at risk of some infections, for example mycoplasma infection, and these will need appropriate intensive treatment.
Depending on the child's degree of understanding, there may be some difficulties in ensuring that appropriate drugs are taken. Here it is clear that schoolteachers and any others involved in care of the child with Down's syndrome must be enlisted as part of the care team.
(published with permission in writing from:http://www.dsrf.co.uk/)
