Modified chemotherapy for pediatric patients with Down syndrome and high-risk B-ALL

During the 65th American Society of Hematology (ASH) Annual Meeting and Exposition, the ALL Hub spoke with Karen Rabin, Texas Children’s Hospital, Houston, US. We asked, Can modified chemotherapy regimens improve outcomes for pediatric patients with Down syndrome and high-risk B-ALL?

Rabin highlights the poor historical outcomes for patients with Down syndrome, including an increased risk of relapse and treatment-related mortality. The prior Children’s Oncology Group trial AALL0232 (NCT00075725) was terminated due to excessive treatment-related mortality due to sepsis and profound neutropenia.

Rabin then discusses data from the recent AALL1131 trial (NCT02883049) investigating a modified chemotherapy regimen to increase safety and improve outcomes; modifications included changing four-drug to three-drug induction, leucovorin rescue after intrathecal methotrexate, modified intravenous methotrexate during interim maintenance, and enhanced supportive care guidelines.