{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:31:38Z","timestamp":1780086698854,"version":"3.54.0"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100017559","name":"Garron Family Cancer Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017559","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2022,3,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Children with leukemia and Down syndrome (DS) are at higher risk of acute treatment toxicities than those without DS. Whether late toxicity risks are also elevated is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors identified all patients diagnosed with leukemia before the age of 18 years in Ontario, Canada between 1987 and 2013 and who survived greater than 5 years since their last pediatric cancer event. Survivors were divided into those with and without DS, matched by birth year, sex, leukemia type, and receipt of radiation. DS survivors were matched to individuals with DS without childhood cancer (DS controls) in a 1:10 ratio. Outcomes were identified through linkage to population\u2010based health services databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>DS survivors (n = 79) experienced inferior overall survival compared to non\u2010DS survivors (n = 231) (20\u2010year overall survival, 81.7% \u00b1 6.8% vs 98.3% \u00b1 1.2%; hazard ratio [HR], 12.8; <jats:italic>P<\/jats:italic> &lt; .0001) and to DS controls (n = 790; 96.3% \u00b1 1.2%; HR, 5.4 <jats:italic>P<\/jats:italic> &lt; .0001). Pulmonary and infectious deaths were noted among DS survivors. There was no difference in the incidence of congestive heart failure between DS survivors and either control cohort, nor of hearing loss or dementia between DS survivors and DS controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>DS survivors were at substantially higher risk of late mortality than non\u2010DS survivors or DS controls. This excess risk was not attributable to cardiac\u2010 or subsequent malignant neoplasm\u2010related late effects, historically main causes of premature death among non\u2010DS survivors. Chronic morbidities associated with DS were not increased compared to DS controls. DS\u2010specific surveillance guidelines may be warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.34042","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T18:30:43Z","timestamp":1638297043000},"page":"1294-1301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Risks of late mortality and morbidity among survivors of childhood acute leukemia with Down syndrome: A population\u2010based cohort study"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-3670","authenticated-orcid":false,"given":"Sumit","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Haematology\/Oncology The Hospital for Sick Children Toronto Ontario Canada"},{"name":"Department of Pediatrics Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Cancer Research Program Institute for Clinical Evaluative Sciences Toronto Ontario 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K.","family":"Hitzler","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology The Hospital for Sick Children Toronto Ontario Canada"},{"name":"Department of Pediatrics Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Developmental and Stem Cell Biology The Hospital for Sick Children Research Institute Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Liu","sequence":"additional","affiliation":[{"name":"Cancer Research Program Institute for Clinical Evaluative Sciences Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0334-0871","authenticated-orcid":false,"given":"Paul C.","family":"Nathan","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology The Hospital for Sick Children Toronto Ontario Canada"},{"name":"Department of Pediatrics Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Cancer Research Program Institute for Clinical Evaluative Sciences Toronto Ontario Canada"},{"name":"Institute for Health Policy, Evaluation and Management University of Toronto Ontario Toronto 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