AVERAGE RISK WITH DOWN SYNDROME • children older than 1 year and younger than 10 years who have been diagnosed with Down syndrome • WBC count lower than 50,000 at diagnosis • no testicular disease • no leukemia in their spinal fluid at diagnosis • no unfavorable cytogenetics such as MLL-rearrangement, hypodiploidy, or Philadelphia chromosome (also called BCR-ABL). 3. High Risk Children who have any of the following factors are considered high risk: • children older than 1 year and younger than 10 years with a WBC greater than 50,000 at diagnosis • children 10 years or older, regardless of WBC count • have testicular disease • have leukemia in their spinal fluid at diagnosis, called CNS-3 • leukemia cells with certain chromosome abnormalities (such as Philadelphia chromosome ALL [also called BCR-ABL] or MLL gene rearrangement) • children who were treated with steroids before the diagnosis of ALL was made • last day of induction therapy MRD greater or equal to 0.01%. 4. Very High Risk • do not have Down syndrome • have a chromosome abnormality: iAMP21, MLL rearrangement, hypodiploidy (< 44 chromosomes or DNA index of < 0.81)
• not in remission by the last day of induction, MRD > 0.01% • unfavorable cytogenetics with Day 29 MRD of > 0.01%.
It is important to determine your child’s risk group so the treatment team can determine the chance for a cure. Because ALL is a cancer of the blood-forming cells in the bone marrow, treatment involves the blood system and entire body. All types of B-cell and T-cell ALL are commonly treated with chemotherapy and sometimes with radiation therapy. Your healthcare team will discuss with you the recommended treatment plan based on your child’s risk group.
Venous Access Device (VAD) A venous access device ( VAD) , sometimes called a central line, is an intravenous (IV) catheter that may be used throughout your child’s course of therapy. The purpose of the VAD is to ensure a safe method of delivering chemotherapy (cancer-fighting drugs) and to decrease the discomfort of having numerous needlesticks. It is inserted during surgery when your child is under sedation or general anesthesia either before chemotherapy
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