Approach to central nervous system leukemia in children from low-middle income countries (LMICs)

Central nervous system (CNS) leukemia remains a diagnostic and therapeutic challenge associated with treatment failure in children. CNS-directed therapy intensification to improve survival outcomes results in long-term neurocognitive deficits in many survivors due to the neurologic insult acquired in the developing brain. With the improved outcomes of childhood leukemia in high income countries, attempts are being made to reduce long-term morbidity without compromising survival outcome. In the near future, immunotherapy and targeted agents might play an increased role in improving childhood leukemia survival with lesser long-term morbidity. Due to the paucity of published literature in low and middle income countries (LMIC), there is a need for streamlining the management of CNS leukemia in children in this setting. This review summarises the available evidences in the management of pediatric CNS leukemia, and discusses practical aspects pertaining to diagnosis and treatment in an LMIC setting.