Pattern and determinants of central nervous system relapse in childhood acute lymphoblastic leukemia in a resource-limited setting

Evaluation and Outcome of Central Nervous System Involvement in Pediatric Acute Lymphoblastic Leukemia in Dar es Salaam, Tanzania

“…Treatment protocols in LMIC are based on outcomes of clinical trials done in HICs, so local research is needed to adjust for limited resources . For example, a cancer center in India that followed international recommendations to omit prophylactic cranial radiation had significantly higher CNS relapse rates in pediatric patients with ALL than their Western counterparts . Whether this rate was due to a greater incidence of high‐risk disease, less aggressive chemotherapy, or a different biology of malignant cells is unknown .…”

“…[8] Whether this rate was due to a greater incidence of high-risk disease, less aggressive chemotherapy, or a different biology of malignant cells is unknown. [8] These factors raise the question of the optimal CNS leukemia prophylaxis and treatment in LMIC.…”

“…For example, a cancer center in India that followed international recommendations to omit prophylactic cranial radiation had significantly higher CNS relapse rates in pediatric patients with ALL than their Western counterparts . Whether this rate was due to a greater incidence of high‐risk disease, less aggressive chemotherapy, or a different biology of malignant cells is unknown . These factors raise the question of the optimal CNS leukemia prophylaxis and treatment in LMIC.…”