{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T03:58:07Z","timestamp":1789012687781,"version":"build-2803163510"},"reference-count":35,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"2","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2024,1,10]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Patients with Down syndrome (DS) and B-ALL experience increased rates of relapse, toxicity, and death. We report results for patients with DS B-ALL enrolled on Children's Oncology Group trials between 2003 and 2019. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> We analyzed data for DS (n = 743) and non-DS (n = 20,067) patients age 1-30 years on four B-ALL standard-risk (SR) and high-risk trials. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> Patients with DS exhibited more frequent minimal residual disease (MRD) \u22650.01% at end induction (30.8% v 21.5%; P &lt; .001). This difference persisted at end consolidation only in National Cancer Institute (NCI) high-risk patients (34.0% v 11.7%; P &lt; .0001). Five-year event-free survival (EFS) and overall survival (OS) were significantly poorer for DS versus non-DS patients overall (EFS, 79.2% \u00b1 1.6% v 87.5% \u00b1 0.3%; P &lt; .0001; OS, 86.8% \u00b1 1.4% v 93.6% \u00b1 0.2%; P &lt; .0001), and within NCI SR and high-risk subgroups. Multivariable Cox regression analysis of the DS cohort for risk factors associated with inferior EFS identified age &gt;10 years, white blood count &gt;50 \u00d7 10<jats:sup>3<\/jats:sup>\/\u03bcL, and end-induction MRD \u22650.01%, but not cytogenetics or CRLF2 overexpression. Patients with DS demonstrated higher 5-year cumulative incidence of relapse (11.5% \u00b1 1.2% v 9.1% \u00b1 0.2%; P = .0008), death in remission (4.9% \u00b1 0.8% v 1.7% \u00b1 0.1%; P &lt; .0001), and induction death (3.4% v 0.8%; P &lt; .0001). Mucositis, infections, and hyperglycemia were significantly more frequent in all patients with DS, while seizures were more frequent in patients with DS on high-risk trials (4.1% v 1.8%; P = .005). <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Patients with DS-ALL exhibit an increased rate of relapse and particularly of treatment-related mortality. Novel, less-toxic therapeutic strategies are needed to improve outcomes. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.23.00389","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T19:59:19Z","timestamp":1698436759000},"page":"218-227","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":28,"title":["Outcomes in Children, Adolescents, and Young Adults With Down Syndrome and ALL: A Report From the Children's Oncology 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