Cancer

Transient myelo-proliferative disorder, which sometimes develops into leukemia, is seen in 10% of neonates with Down syndrome. Polycythemia is also common in infancy. But the most significant forms of cancer in youngsters with Down syndrome is leukemia.

Marlow et al. (2021) studied 3.9 million children born from 1996 to 2016 in healthcare systems in the US and Canada. Leukemia was diagnosed in 124 of the 4401 children (0.028%) with Down syndrome.
Here’s the breakdown of the incidences of the different types of leukemia in children with down syndrome within different ages:

• Acute myeloid leukemia (AML) = 1405/100,000 at age 4 years and unchanged at age 14 years.
• Acute lymphoid leukemia in children with Down syndrome was 1059/100, 000 at age 4 but great with age at 1714/100 000 at age 14 years.
• Children with Down syndrome had a greater risk of AML before age 5 years than other children. Largest hazard ratios were for megakaryoblast leukemia before age 5 years (HR 1500).
• Children with Down syndrome had a greater risk of acute lymphoid leukemia than other children regardless of age.

This study showed a greater incidence of AML in children with Down Syndrome than previously reported (Marlow et al, 2021).

Survival statistics

Children with Down syndrome who develop AML, with treatment have a survival rate of 80%. This is much higher than the 35% survival rate of non-Down syndrome children with similar leukemic subtypes (Caldwell et al., 2014).

According to the American Cancer society, the survival rate with treatment for all children who develop acute lymphoid leukemia is about 90%. https://www.cancer.org/cancer/leukemia-in-children/detection-diagnosis-staging/survival-rates.html.
Nurses caring for these children should report any signs of early leukemia to the primary health care provider, including:
• fatigue over a 2–6-week period
• fever
• pallor
• easy bruising or hemorrhages
• joint or bone pain
• life-threatening systemic infection or hemorrhage

References:

Caldwell, J. T., Ge, Y. & Taub, J. W. (2014). Prognosis and management of acute myeloid leukemia in patients with Down syndrome. Expert review of hematology, 7(6), 831–840. https://doi.org/10.1586/17474086.2014.959923.

Marlow, E. C., Ducore, J., Kwan, M. L., Weinmann, S., Smith-Bindman, R. & Miglioretti, D. L. (2021). Leukemia Risk in a Cohort of 3.9 Million Children with and without Down Syndrome. Journal of Pediatrics. Online first. https://doi.org/10.1016/j.jpeds.2021.03.001.