Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in Argentina
Children with Down syndrome (DS) are at an increased risk of developing clonal myeloproliferative disorders. The balance between treatment intensity and treatment-related toxicity has not yet been defined. We analyzed this population to identify risk factors and optimal treatment. This single-center...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-07-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/14/13/3286 |
| _version_ | 1797480647939325952 |
|---|---|
| author | Carla L. Pennella Tamara Muñoz Cassina Jorge G. Rossi Edgardo M. Baialardo Patricia Rubio María A. Deu Luisina Peruzzo Myriam R. Guitter Cristian G. Sanchez de La Rosa Elizabeth M. Alfaro María S. Felice |
| author_facet | Carla L. Pennella Tamara Muñoz Cassina Jorge G. Rossi Edgardo M. Baialardo Patricia Rubio María A. Deu Luisina Peruzzo Myriam R. Guitter Cristian G. Sanchez de La Rosa Elizabeth M. Alfaro María S. Felice |
| author_sort | Carla L. Pennella |
| collection | DOAJ |
| description | Children with Down syndrome (DS) are at an increased risk of developing clonal myeloproliferative disorders. The balance between treatment intensity and treatment-related toxicity has not yet been defined. We analyzed this population to identify risk factors and optimal treatment. This single-center retrospective study included 78 DS patients <16 years-old with Transient Abnormal Myelopoiesis (TAM, <i>n</i> = 25), Acute Myeloblastic Leukemia (DS-AML, <i>n</i> = 41) of which 35 had classical Myeloid Leukemia associated with DS (ML-DS) with megakaryoblastic immunophenotype (AMKL) and 6 sporadic DS-AML (non-AMKL). Patients with DS-AML were treated according to four BFM-based protocols. Classical ML-DS vs. non-DS-AMKL were compared and the outcome of ML-DS was analyzed according to treatment intensity. Only four patients with TAM required cytoreduction with a 5-year Event-Free Survival probability (EFSp) of 74.4 (±9.1)%. DS-AML treatment-related deaths were due to infections, with a 5-year EFSp of 60.6 (±8.2)%. Megakaryoblastic immunophenotype was the strongest good-prognostic factor in univariate and multivariate analysis (<i>p</i> = 0.000). When compared ML-DS with non-DS-AMKL, a better outcome was associated with a lower relapse rate (<i>p</i> = 0.0002). Analysis of administered treatment was done on 32/33 ML-DS patients who achieved CR according to receiving or not high-dose ARA-C block (HDARA-C), and no difference in 5-year EFSp was observed (<i>p</i> = 0.172). TAM rarely required treatment and when severe manifestations occurred, early intervention was effective. DS-AML good outcome was associated with AMKL with a low relapse-rate. Even if treatment-related mortality is still high, our data do not support the omission of HDARA-C in ML-DS since we observed a trend to detect a higher relapse rate in the arm without HDARA-C. |
| first_indexed | 2024-03-09T22:03:05Z |
| format | Article |
| id | doaj.art-f0c11f377874466ab4cf484499521522 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T22:03:05Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-f0c11f377874466ab4cf4844995215222023-11-23T19:47:25ZengMDPI AGCancers2072-66942022-07-011413328610.3390/cancers14133286Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in ArgentinaCarla L. Pennella0Tamara Muñoz Cassina1Jorge G. Rossi2Edgardo M. Baialardo3Patricia Rubio4María A. Deu5Luisina Peruzzo6Myriam R. Guitter7Cristian G. Sanchez de La Rosa8Elizabeth M. Alfaro9María S. Felice10Department of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Immunology and Rheumatology, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Genetics, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaDepartment of Hematology-Oncology, Hospital de Pediatría S.A.M.IC. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos 1881, Buenos Aires C 1245 AAM, ArgentinaChildren with Down syndrome (DS) are at an increased risk of developing clonal myeloproliferative disorders. The balance between treatment intensity and treatment-related toxicity has not yet been defined. We analyzed this population to identify risk factors and optimal treatment. This single-center retrospective study included 78 DS patients <16 years-old with Transient Abnormal Myelopoiesis (TAM, <i>n</i> = 25), Acute Myeloblastic Leukemia (DS-AML, <i>n</i> = 41) of which 35 had classical Myeloid Leukemia associated with DS (ML-DS) with megakaryoblastic immunophenotype (AMKL) and 6 sporadic DS-AML (non-AMKL). Patients with DS-AML were treated according to four BFM-based protocols. Classical ML-DS vs. non-DS-AMKL were compared and the outcome of ML-DS was analyzed according to treatment intensity. Only four patients with TAM required cytoreduction with a 5-year Event-Free Survival probability (EFSp) of 74.4 (±9.1)%. DS-AML treatment-related deaths were due to infections, with a 5-year EFSp of 60.6 (±8.2)%. Megakaryoblastic immunophenotype was the strongest good-prognostic factor in univariate and multivariate analysis (<i>p</i> = 0.000). When compared ML-DS with non-DS-AMKL, a better outcome was associated with a lower relapse rate (<i>p</i> = 0.0002). Analysis of administered treatment was done on 32/33 ML-DS patients who achieved CR according to receiving or not high-dose ARA-C block (HDARA-C), and no difference in 5-year EFSp was observed (<i>p</i> = 0.172). TAM rarely required treatment and when severe manifestations occurred, early intervention was effective. DS-AML good outcome was associated with AMKL with a low relapse-rate. Even if treatment-related mortality is still high, our data do not support the omission of HDARA-C in ML-DS since we observed a trend to detect a higher relapse rate in the arm without HDARA-C.https://www.mdpi.com/2072-6694/14/13/3286Down Syndromeacute myeloid leukemiatransient abnormal myelopoiesismegakaryoblastic leukemiachemotherapyoutcome research |
| spellingShingle | Carla L. Pennella Tamara Muñoz Cassina Jorge G. Rossi Edgardo M. Baialardo Patricia Rubio María A. Deu Luisina Peruzzo Myriam R. Guitter Cristian G. Sanchez de La Rosa Elizabeth M. Alfaro María S. Felice Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in Argentina Cancers Down Syndrome acute myeloid leukemia transient abnormal myelopoiesis megakaryoblastic leukemia chemotherapy outcome research |
| title | Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in Argentina |
| title_full | Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in Argentina |
| title_fullStr | Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in Argentina |
| title_full_unstemmed | Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in Argentina |
| title_short | Clonal Myeloproliferative Disorders in Patients with Down Syndrome—Treatment and Outcome Results from an Institution in Argentina |
| title_sort | clonal myeloproliferative disorders in patients with down syndrome treatment and outcome results from an institution in argentina |
| topic | Down Syndrome acute myeloid leukemia transient abnormal myelopoiesis megakaryoblastic leukemia chemotherapy outcome research |
| url | https://www.mdpi.com/2072-6694/14/13/3286 |
| work_keys_str_mv | AT carlalpennella clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT tamaramunozcassina clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT jorgegrossi clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT edgardombaialardo clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT patriciarubio clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT mariaadeu clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT luisinaperuzzo clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT myriamrguitter clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT cristiangsanchezdelarosa clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT elizabethmalfaro clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina AT mariasfelice clonalmyeloproliferativedisordersinpatientswithdownsyndrometreatmentandoutcomeresultsfromaninstitutioninargentina |