How I Approach Treatment of Relapsed Acute Lymphoblastic Leukemia in Patients With Down Syndrome

Children with Down syndrome (DS) experience excessive treatment-related mortality (TRM), primarily due to infectious complications, during treatment for acute lymphoblastic leukemia (ALL). This risk further increases during the intensive chemotherapy required to treat a relapse of ALL, limiting the feasibility of conventional intensive relapse chemotherapy. Anti-cluster of differentiation 19 (CD19) chimeric antigen receptor (CAR) T-cell therapy is an emerging treatment option for children with DS and relapsed B-ALL, including those in first relapse. This approach has demonstrated promising efficacy while potentially reducing the TRM associated with intensive salvage chemotherapy. Access to this form of immunotherapy for patients with DS and relapsed B-ALL is strongly encouraged.