title: Evaluation and Outcome of Central Nervous System Involvement in Pediatric Acute Lymphoblastic Leukemia in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  Outcomes for acute lymphoblastic leukemia (ALL) in low-income countries lag far behind high-income countries (HIC). We explored the impact of central nervous system (CNS) involvement on outcome of pediatric patients with ALL in Tanzania.
  
  
  METHODS
  Comprehensive chart review was performed to characterize CNS involvement, treatment, and outcomes of pediatric patients with ALL at Muhimbili National Hospital in Dar es Salaam, Tanzania between January 1, 2011 and December 31, 2013.
  
  
  RESULTS
  One hundred fifty-six patients with confirmed ALL had accessible data, and 128 initiated therapy. Sixteen percent of 156 patients had a documented cerebral spinal fluid analysis by cytospin. Seventy patients (45%) had a documented lumbar puncture with intrathecal (IT) therapy within 1 week of diagnosis. Thirteen patients presented with CNS involvement at diagnosis based on cytospin and/or unequivocal symptoms. Twenty-one patients (16%) experienced CNS relapse, three of whom had CNS disease at diagnosis. Median event-free survival (EFS) for all patients was 7.9 months and estimated EFS at 24 months was 31%. For the patients with CNS involvement at diagnosis, the estimated EFS at 24 months was 45%. Only three of 21 patients with CNS relapse were still alive with a median follow up of 3 months.
  
  
  CONCLUSIONS
  The rate of CNS disease in patients with ALL in Dar es Salaam at diagnosis and relapse was higher than that reported in HIC, and overall survival was lower. Improving outcomes will require further advances including consistent CNS prophylaxis and may include targeting high-risk patients with additional IT treatments.
authors.affiliation: Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohler
authors.affiliation: Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Shakilu
authors.initials: S
authors.lastname: Jumanne
authors.affiliation: Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Jane
authors.initials: J
authors.lastname: Kaijage
authors.affiliation: Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California.
authors.forename: Steven G
authors.initials: SG
authors.lastname: DuBois
authors.affiliation: Department of Pediatrics, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Patricia
authors.initials: P
authors.lastname: Scanlan
authors.affiliation: Department of Pediatrics, UCSF School of Medicine and UCSF Benioff Children's Hospital, University of California, San Francisco, California.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
mesh_terms: D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D013636:Tanzania; D016896:Treatment Outcome
keywords: acute lymphoblastic leukemia; central nervous system; low-income country