Evaluation and Outcome of Central Nervous System Involvement in XXXX in Dar es Salaam, Tanzania.

@entity1 @entity6220 @entity981 @entity1349
BACKGROUND: Outcomes for @entity981 ( @entity981 ) 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 @entity1 with @entity981 in Tanzania. PROCEDURE: Comprehensive chart review was performed to characterize CNS involvement, treatment, and outcomes of pediatric @entity1 with @entity981 at Muhimbili National Hospital in Dar es Salaam, Tanzania between January 1, 2011 and December 31, 2013. RESULTS: One hundred fifty-six @entity1 with confirmed @entity981 had accessible data, and 128 initiated therapy. Sixteen percent of 156 @entity1 had a documented cerebral spinal fluid analysis by cytospin. Seventy @entity1 (45%) had a documented lumbar puncture with intrathecal (IT) therapy within 1 week of diagnosis. Thirteen @entity1 presented with CNS involvement at diagnosis based on cytospin and/or unequivocal symptoms. Twenty-one @entity1 (16%) experienced CNS relapse, three of whom had @entity6220 at diagnosis. Median @entity1349 ( @entity1349 ) for all @entity1 was 7.9 months and estimated @entity1349 at 24 months was 31%. For the @entity1 with CNS involvement at diagnosis, the estimated @entity1349 at 24 months was 45%. Only three of 21 @entity1 with CNS relapse were still alive with a median follow up of 3 months. CONCLUSIONS: The rate of @entity6220 in @entity1 with @entity981 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 @entity1 with additional IT treatments.
