Optimal treatment intensity in children with Down syndrome and myeloid leukaemia: data from 56 children treated on NOPHO-AML protocols and a review of the literature

Abstract Children with Down syndrome (DS) and myeloid leukaemia have a significantly higher survival rate than other children, but they also experience considerable treatment-related toxicity. We analysed data on 56 children with DS who were treated on the Nordic Society for Paediatric Haematology and Oncology-acute myeloid leukaemia (NOPHO-AML)88 and NOPHO-AML93 protocols and reviewed the literature. In the dose-intensive NOPHO-AML88 protocol, 8 out of 15 patients (53%) experienced an event. In the less dose-intensive NOPHO-AML93 protocol, 7 out of 41 patients (17%) had an event. Therapy was reduced in 29 patients (52%) with in average 75% and 67% of the scheduled dose of anthracycline and cytarabine, respectively. Treatment-related death occurred in seven who all received full treatment. Relapse and resistant disease occurred at a similar rate in those receiving full and reduced treatment. Review of major series of myeloid leukaemia of DS showed no clear relationship between dose and survival; however, it appears that both a reduction in treatment dose and a less intensively timed treatment regimen improved the outcome. Further studies are needed to define the optimal regimen for treating myeloid leukaemia of DS

Unidentified actor as Hassan, an unidentified actor as the Caliph and the soldiers in the J.C. Williamson London production of Hassan and how he came to make the golden journey to Samarkand, act 5 scene 1 The garden, 1923 [picture] /

From: Hassan : and how he came to make the golden journey to Samarkand / James Elroy Flecker ; arranged for the stage by Basil Dean ; music by Frederick Delius.; Condition: Damage on edges.; Inscriptions: "Caliph ordering Hassan to see the torture"--Handwritten, on verso.; Part of the collection: J.C. Williamson collection of photographs.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.pic-vn3805710; No programs held in PROMPT collection