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This risk further increases during the intensive chemotherapy required to treat a relapse of ALL, limiting the feasibility of conventional intensive relapse chemotherapy. Anti\u2010cluster of differentiation 19 (CD19) chimeric antigen receptor (CAR) T\u2010cell therapy is an emerging treatment option for children with DS and relapsed B\u2010ALL, 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\u2010ALL is strongly encouraged.<\/jats:p>","DOI":"10.1002\/1545-5017.70467","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T02:43:16Z","timestamp":1785379396000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How I Approach Treatment of Relapsed Acute Lymphoblastic Leukemia in Patients With Down Syndrome"],"prefix":"10.1002","volume":"73","author":[{"given":"Amanda M.","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pediatrics British Columbia Children's Hospital University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen R.","family":"Rabin","sequence":"additional","affiliation":[{"name":"University of California San Francisco and Benioff Children's Hospitals  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1158-186X","authenticated-orcid":false,"given":"Johann K.","family":"Hitzler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102013\u201006\u2010509463"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.00389"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102009\u201007\u2010235291"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng.469"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023019765"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(21)00272\u20106"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023020508"},{"key":"e_1_2_11_9_1","first-page":"787","article-title":"Improvement in the Infection\u2010Related Mortality for Children With Down Syndrome (DS) in Contemporary Children's Oncology Group (COG) Acute Lymphoblastic Leukemia (ALL) Clinical Trials","volume":"54","author":"Maloney K.","year":"2010","journal-title":"Pediatric Blood & Cancer"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102014\u201003\u2010560847"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2020.38.15_suppl.10510"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.00389"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102249.2011.04335.x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102249.2009.03890.x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.07.015"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10875\u2010020\u201000805\u20107"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.celrep.2019.10.038"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2022.09.007"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019032094"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12739"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27256"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2019.224774"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12348"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.0669"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27644"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01692"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25620"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25658"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021005564"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(89)80603-1"},{"issue":"2","key":"e_1_2_11_31_1","first-page":"453","article-title":"Unrelated Donor Bone Marrow Transplantation for Acute Leukemia in Patients With Down's Syndrome","volume":"18","author":"Pawlowska A. 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