How do you treat late medullary relapsed B-ALL in a patient with Down Syndrome?  

I have had this exact case. My patient did not tolerate (nearly died of sepsis) with the relapsed ALL COG therapy - so I used standard risk Down syndrome ALL therapy just like a newly diagnosed ALL, standard risk DS - after that, I have kept her on pseudo-maintenance (just 6MP & po MTX) for 5 ye...