Landmark new genetic testing has been developed to detect signs of a potentially fatal condition that can develop into full blown leukaemia in children with Down’s syndrome.
- Early intervention greatly increases survival chances for children who develop symptoms. All children with Down’s syndrome will receive a blood test within three days of birth to identify if they are at risk.
- Despite children with Down’s syndrome having around a one in 50 chance of developing acute myeloid leukaemia (AML), compared to a one in 7,000 chance for children without Down’s syndrome, monitoring procedures have been unclear until now.
New clinical guidelines, published today in the British Journal of Haematology, are a result of years of research and clinical studies by researchers at the University of Oxford, funded by the charities Bloodwise and Children with Cancer UK.
It is expected that the guidelines will become the international gold standard of care for children with Down’s syndrome, changing the way that newborns at a high risk of leukaemia are treated.
Around one in 10 children with Down’s syndrome are born with a pre-leukaemic condition known as ‘Transient Leukaemia of Down syndrome’ (TL-DS). This condition, which is also sometimes called “TAM”, goes on to develop into acute myeloid leukaemia of Down Syndrome (ML-DS) in one in five cases.
TL-DS itself carries significant risks, with up to one in five children with the severe form dying within six months of diagnosis as a result of the condition – most commonly from liver dysfunction.
The new clinical guidelines recommend that a full blood count, which measures levels of different types of blood cell in the blood, is taken within three days of birth in children with Down’s syndrome. All newborns with Down’s syndrome should also be examined for signs of TL-DS, which include organ enlargement, liver dysfunction and skin rashes.
Mutations to the GATA1 gene, which is important to healthy blood production, are found in both TL-DS and ML-DS in children with Down’s syndrome. If blood counts reveal that there are high levels of immature ‘blast’ cells in the bloodstream and there are physical symptoms, babies should be screened for the GATA1 mutation – a test that was developed by the Oxford group.
The outcome for children with TL-DS who develop severe liver dysfunction and other complications is significantly improved by early intervention with low-dose chemotherapy. Children with TL-DS who do not experience life-threatening symptoms should be monitored for a number of years to check for any signs of progression into leukaemia.
Carol Boys, Chief Executive of the Down’s Syndrome Association: “This is fantastic news and a huge step forward for the surveillance, treatment and management of Leukaemia in children with Down’s syndrome. Guidelines of this kind are exactly what the Down’s Syndrome Association and Down Syndrome International are striving to achieve for all of the health conditions that can affect people with Down’s syndrome.”
Professor Irene Roberts, at the University of Oxford, who led the research said: “Until now guidelines for the treatment of children with Down’s syndrome at risk of developing leukaemia have been vague, implementation has been haphazard and children have been diagnosed late as a result. Early intervention greatly increases children’s chances of survival if symptoms do develop, helping to save lives.”
Professor Paresh Vyas, from the University of Oxford, said: “A simple test can ensure that those children at risk of cancer are put under the care of a specialist paediatrician. They are properly monitored and are treated straight away when symptoms develop. Importantly, it also provides reassurance to the parents of those children not at risk, removing the fear and worry of leukaemia for many families.”
Dr Alasdair Rankin, Director of Research at Bloodwise, said: “Step-changes in care for people with blood cancer don’t always come from new drugs – new tests and guidance for how doctors deliver care can make a huge difference very quickly. This new diagnostic test, the new clinical guidelines and the excellent research that has delivered them will change the lives of children with Down’s syndrome and their families. Bloodwise will be keen to make sure that testing is available nationally for all newborns with Down’s syndrome and that the new guidance is followed in practice.”
Cliff O’Gorman, Chief Executive of Children with Cancer UK, said: “Children with Down’s syndrome are far more likely to develop acute myeloid leukaemia than those without – yet until now testing and monitoring for signs of the condition has been inconsistent.
“Early intervention is crucial and these new clinical guidelines will help ensure that children with Down’s syndrome who develop signs of myeloid leukaemia have the best possible chance of survival. It is vital that we continue to fund pioneering research to improve the quality of care for young cancer patients, and keep more families together.”
For further information, please contact the Bloodwise Press Office on 020 7269 9019, press mobile 07824 375880, or email: press@bloodwise.org.uk
If you have any concerns or questions relating to this news story or about the health and well being of children or adults with Down’s syndrome, please contact our Helpline.
You can call them on 0333 1212 300 from Monday to Friday, 10am-4pm or drop them an email on info@downs-syndrome.org.uk
