Should we treat children with down syndrome and leukemia in the developing world?

摘要

Down syndrome (DS), also known as trisomy 21, has an incidence of 1 in 920 live births in India [1]. A wide variety of hematological disorders have been documented in trisomy 21. DS children have an approximately 10- to 20-fold higher incidence of leukemia than non-DS children [2]. Newborns with DS can show a transient myelopro-liferative disorder (TMD), which usually disappears spontaneously, but up to 30% can subsequently develop acute megakaryoblastic leukemia [3]. Acute myeloid leukemia (AML) predominates in DS children under 4 years of age, a marked increase of the megakaryoblastic subtype was seen in these patients [3].In India, abandonment of care in patients with hematological malignancies is a significant challenge due to multiple and complex social issues such as poverty, living far distances from health facilities, lack of education and health information for patients, and gender inequality [4]. In non-DS acute lymphoblastic leukemia (ALL), although the outcome has improved, sepsis still remains a major barrier in improving outcome [5]. Outcome of pediatric AML in India is poor because of sepsis, high relapse rates, and treatment abandonment [6]. In a country with such barriers to cure of childhood leukemia, should children with DS and leukemia be offered therapy? Here we describe our experience at a single center of outcomes in these children after diagnosis.