Is the Leukemia in DS Biologically Different Based on Age at Diagnosis?
A closer examination of the data of Gamis et al suggests that the risk varies within age groups: “Patients who had AML that was diagnosed between ages 0 to 2 years (n = 94) had a 6-year EFS of 86%, those older than 2 to 4 years (n = 58) had a 70% EFS, and those older than 4 years (n = 9) had a 28% EFS.” Thus, for children with DS who are older than 4 years, the EFS is markedly inferior, and is the same as for non-DS children without DS with AML receiving the “standard timing 4 day course” of the dexamethasone, cytarabine, 6-thioguanine, etoposide, and rubidomycin (DCTER) regimen (EFS 21% standard induction- see abstract of Gamis et al8). No data are presented separately for the 2 to 3 and 3 to 4 years age groups, nor are there any details of the individual cases of those older than 4 years. Regardless, the markedly inferior outcome in those 4 years or older would create a “Will Rogers” phenomenon, whether the age cut is at 2 or 3 years, because of stage or risk migration.9 Since the ov
