Children with Down syndrome are predisposed to leukemia, and have substantially higher survival rates and lower relapse rates.

• A. True
• B. False
• C. Not predisposed
• D. Unknown

Answer: (A)

Children with Down syndrome have a higher risk of developing leukemia than the general pediatric population, due to the genetic changes associated with trisomy 21 that affect hematopoiesis. Among the leukemias that occur in Down syndrome, the most notable difference is seen with Down syndrome–associated AML (often megakaryoblastic AML), which tends to respond well to chemotherapy in many patients, resulting in favorable survival and relatively lower relapse rates compared with some other pediatric AML groups. This pattern helps explain why the statement can be viewed as true: the predisposition is real, and the outcomes for DS-associated leukemia, particularly AML, can be substantially better with current treatment approaches. It’s worth noting that DS-associated ALL has historically posed more treatment-related challenges, though modern regimens have improved outcomes; the overall take-home is that there is a real predisposition plus outcomes that, in many cases, show strong survival with appropriate therapy.