Treating Smarter, Not Harder: Abandoning Intensification and Replacing with Immunotherapy for Patients with Down Syndrome and B-ALL (C234)

2:15 – 3:15 pm Saturday, October 30

coglogoChildren with Down syndrome (DS) have a striking predisposition for developing acute leukemia, with a 40-fold increased risk of developing acute lymphoblastic leukemia (ALL) compared to non-DS patients (Wadhwa et al, 2017). Approximately 3% of children with ALL have DS, and these children have inferior outcomes and higher rates of treatment-related mortality (TRM) and are at greater risk of relapse (Buitenkamp et al., 2014).

Significant supportive care strategies have been implemented in recent protocols, but TRM rates have remained significantly higher for DS B-ALL patients despite these efforts (Rabin et al., 2015). Children with DS are uniquely sensitive to side effects from chemotherapy, and toxicity in this population led to temporary suspensions of DS treatment arms on previous clinical trials AALL0331 and AALL0232. Therefore, the Children’s Oncology Group (COG) is testing the immunotherapy blinatumomab in children with DS B-ALL with the aim of increasing survival and minimizing toxicity. Blinatumomab has been safely used in children with DS and relapsed B-ALL (von Stackelberg et al., 2016; Wadhwa, Kutny, & Xavier, 2017). COG protocol AALL1731 is a phase three clinical trial investigating the addition of blinatumomab to standard chemotherapy in patients classified as standard risk (SR). Patients with SR DS will be eligible for randomization and high-risk B-ALL and DS (DS-High) patients will have a unique treatment arm that includes three cycles of blinatumomab. AALL1731 has a correlative study aimed at exploring the neurocognitive, functional, and quality of life outcomes in DS-ALL patients. There is an urgent need to understand this impact because patients with preexisting neurodevelopmental conditions have been excluded from neurocognitive studies in childhood cancer. In this session, nurses will learn about the treatment of patients with DS B-ALL on AALL1731, the rationale behind the intensified supportive care measures specific for patients with DS, and the unique impacts of therapy for patients with DS B-ALL.