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Acute Lymphoblastic Leukemia with Central Nervous System Involvement—Challenges in Management

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Abstract

The survival of patients with acute lymphoblastic leukemia (ALL) has dramatically improved during the last six decades. This improvement is secondary to improved diagnostics, risk stratification of treatment by biological features and response to treatment, improved supportive care, and the introduction of new treatment modalities such as immunotherapy and molecular targeted therapy. However, many questions remain concerning the involvement of the central nervous system (CNS) in leukemia, including ones pertaining to the risk factors for CNS involvement and relapse, the optimal treatment strategy to prevent relapse, and the role of newer therapies. This review discusses these questions by addressing the diagnosis of CNS leukemia, the current clinical trial data for treatment regimens with CNS activity, and issues specific to treatment in low- and middle-income countries (LMICs).

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Acknowledgements

The authors thank Keith A. Laycock, PhD, ELS, for scientific editing of the manuscript.

Funding

This work was supported by the National Cancer Institute (Cancer Center Support CORE Grant CA21765) (S.S. and H.I.) and by the American Lebanese Syrian Associated Charities (ALSAC) (S.S. and H.I). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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  1. Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA

    Shruthi Suryaprakash & Hiroto Inaba

  2. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    Shruthi Suryaprakash & Hiroto Inaba

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  1. Shruthi Suryaprakash
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  2. Hiroto Inaba
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SS and HI equally contributed to the writing of the manuscript; HI also provided guidance to the writing of the manuscript. HI will act as the guarantor for this manuscript.

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Correspondence to Hiroto Inaba.

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Suryaprakash, S., Inaba, H. Acute Lymphoblastic Leukemia with Central Nervous System Involvement—Challenges in Management. Indian J Pediatr 91, 59–66 (2024). https://doi.org/10.1007/s12098-023-04731-5

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