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Multi-institutional analysis of central nervous system germ cell tumors in patients with Down syndrome
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  • Micah Harris,
  • Richard Graham,
  • Andrea Cappellano,
  • ashley margol,
  • George Michaiel,
  • John Crawford,
  • Myrsini Ioakeim-Ioannidou,
  • Joseph Stanek,
  • Kevin Liu,
  • shannon Macdonald,
  • Mohamed Abdelbaki
Micah Harris
The Ohio State University College of Medicine

Corresponding Author:micah.harris@osumc.edu

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Richard Graham
Cincinnati Children's Hospital Medical Center
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Andrea Cappellano
UNIFESP
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ashley margol
Children's Hospital of Los Angeles
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George Michaiel
Children's Hospital of Los Angeles
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John Crawford
Children's Hospital of Orange County
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Myrsini Ioakeim-Ioannidou
Massachusetts General Hospital
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Joseph Stanek
Nationwide Childrens Hospital
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Kevin Liu
Massachusetts General Hospital
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shannon Macdonald
Massachusetts General Hospital
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Mohamed Abdelbaki
Washington University School of Medicine in Saint Louis
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Abstract

Purpose: Primary germ cell tumors (GCTs) are the most common central nervous system (CNS) neoplasm in patients with Down syndrome (DS). However, a standard-of-care has not been established due to a paucity of data. Methods: A retrospective multi-institutional analysis was conducted, in addition to a comprehensive review of the literature. Results: Ten patients from six institutions (five USA, one Brazil) were identified, in addition to 31 patients in the literature from 1975 to 2021. Of the 41 total patients (mean age 9.9 years; 61% male), 16 (39%) had non-germinomatous germ cell tumors (NGGCTs), 16 (39%) had pure germinomas and eight (19.5%) had teratomas. Basal ganglia was the most common tumor location (n=13; 31.7%), followed by posterior fossa (n=7; 17%). Nine patients (22%) experienced disease relapse or progression, of which four died from tumor progression (one germinoma, three teratomas). Sixteen patients (39%) experienced treatment-related complications, of which eight (50%) died (five germinomas, three NGGCTs). Of the germinoma patients, two died from chemotherapy-related sepsis, one from post-surgery cardiopulmonary failure, one from pneumonia and one from Moyamoya following radiation-therapy (RT). Of the NGGCT patients, one died from chemotherapy-related sepsis, one from post-surgical infection and one from pneumonia following surgery/chemotherapy/RT. Three-year overall survival was 66% for all histological types – 62% germinomas, 79% for NGGCTs, and 53% for teratomas. Conclusion: Patients with DS treated for CNS GCTs are at an increased risk of treatment-related adverse events. A different therapeutic approach may need to be considered to mitigate treatment-related complications and long-term neurocognitive sequelae.
09 Apr 2022Submission Checks Completed
09 Apr 2022Assigned to Editor
09 Apr 2022Submitted to Pediatric Blood & Cancer
11 Apr 2022Reviewer(s) Assigned
18 Apr 2022Review(s) Completed, Editorial Evaluation Pending
18 Apr 2022Editorial Decision: Revise Minor
03 May 2022Submission Checks Completed
03 May 2022Assigned to Editor
03 May 20221st Revision Received
06 May 2022Reviewer(s) Assigned
12 May 2022Review(s) Completed, Editorial Evaluation Pending
17 May 2022Editorial Decision: Accept
10 Jun 2022Published in Pediatric Blood & Cancer. 10.1002/pbc.29830