What adjustments, if any, do you make to chemotherapy regimens for patients with chromosomal breakage disorders who develop malignancy?

Patients with known DNA repair disorders (such as Ataxia-Telangiectasia, Nijmegen Breakage Syndrome) are at high risk of developing toxicity from standard chemotherapy approaches for the treatment of their leukemia/lymphoma, which is the most common malignancy they are predisposed to.

Agata Pastorczak and colleagues have written an excellent review which advises specific recommendations for dose reduction of chemotherapy, radiation-sparing approaches, and enhanced supportive care guidelines.

If ...