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Background: The prevalence of Non-Hodgkin lymphoma (NHL) has waxed and waned with the trends in HIV prevalence over the years. The clinical landscape as well as treatment experience in Africa has not earned the much needed attention.
Aim: This study aimed at giving insight to the clinical and laboratory variations as well as treatment outcomes in NHL in a group of Nigerian patients.
Methods: The clinical and laboratory details were obtained from all patients diagnosed with NHL from October 2015 to December 2018 in 3 tertiary health institutions in Nigeria. These were the patients seen or admitted to the Haemato-Oncology clinics and wards. They were followed-up till the time of this write-up, while those that were lost to follow-up were also noted.
Results: There were 77 patients in the study aged 16 to 81 years with a median age of 50 years. These include 45 males and 32 females. Majority (53.7%, n=36/67) of them had no palpable splenomegaly at diagnosis. Of 57 patients, 26.3% (n=15/57) had diffuse large B cell lymphoma, 15.8% (n=9/57) small lymphocytic lymphoma while 10.5% (n=6/57) each had intermediate and high grade lymphoma 14% (n=8/57). The other histological types seen were Follicular lymphoma 3.5%, Cutaneous T cell lymphoma 5.3%, maltoma 7% and bone marrow lymphoma 3.5%.
Patients with ≤ stage 2 Ann-Arbor were 16/66, while majority (40/66) were > stage 2 at diagnosis. The median haemoglobin concentration remained stable from 9.8g/dl at diagnosis to 12.3g/dl at 6 months, while the absolute neutrophil count dropped from 2.4 x 109/l to 1.2 x 109/l. The median leucocyte count at diagnosis was 6.8 x 109/l, while the platelet count was 185 x 109/l, both parameters were 5.3 and 187 x 109/L at six months post-diagnosis, respectively. Of the 64 patients who had their HIV status documented 7 were positive, giving prevalence rate of 12.6%.
Only 14 (18%) out of all the patients had immunophenotyping and only 8 of them were CD20 positive. Relapse rate among the cohort was 43.3% (26/60) while 34 (56.7%) were still on remission. 22 (30.6%) patients were lost to follow up, 18 (25%) had died while 32 (44.4%) were alive and had been seen in the clinic out of 72 patients recorded. The median follow-up time was 10 months and ranged from 0 to 45 months and the mean time of remission was 12 months (range 0-125.) Majority of the patients (55.5%, 35/63) received CHOP with or without Rituximab, 7.9% (5/63) received COAP as first line chemotherapy, while 13/63 (20.6%) had their regimen switched either due to relapse or sub-optimal response, while 10/63 (15.8%) received other combinations. Only 7 patients got Rituximab in combination with any regimen.
Conclusion: The management modalities and treatment outcomes for NHL in most resource-poor countries are sub-optimal and need to be adopted to suit the available resources in these areas and optimize survival /response. The use of treatment algorithms with expensive and unavailable chemotherapeutic agents may not suffice and cheaper available combinations maybe advocated for use in situations where the desirable is not available.
Zhang Y, Dai Y, Zheng T, Ma S. Risk factors of Non-hodgkin Lymphoma. Expert Opin Med Diagn. 2011;5(6):539-50.
Nieters A, Beckmann L, Deeg E, Becker N. Gene polymorphisms in Toll-like receptors, interleukin-10, and interleukin-10 receptor alpha and lymphoma risk. Genes Immun. 2006;7(8):615-24.
Naresh KN, Raphael M, Ayers L, Hurwitz N, Calbi V, Rogena E, et al. Lymphomas in sub-Saharan Africa--what can we learn and how can we help in improving diagnosis, managing patients and fostering translational research? Br J Haematol. 2011;154(6):696-703.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225-49.
Kagu MB, Ahmed SG, Bukar AA, Mohammed AA, Mayun AA, Musa AB. Spectrum of haematologic malignancies and survival outcomes of adult lymphomas in Maiduguri, North Eastern Nigeria--a fourteen year review. Afr J Med Med Sci. 2013;42(1):5-14.
Omoti CE, Halim NK. Adult malignant lymphomas in University of Benin Teaching Hospital, Benin City, Nigeria--incidence and survival. Niger J Clin Pract. 2007;10(1):10-4.
Shi Y, Han Y, Yang J, Liu P, He X, Zhang C, et al. Clinical features and outcomes of diffuse large B-cell lymphoma based on nodal or extranodal primary sites of origin: Analysis of 1,085 WHO classified cases in a single institution in China. Chin J Cancer Res. 2019;31(1):152-61.
Takamatsu H, Araki R, Nishimura R, Yachie A, Espinoza JL, Okumura H, et al. Epstein-Barr virus-associated leukemic lymphoma after allogeneic stem cell transplantation. J Clin Virol. 2016;80:82-6.
Bassig BA, Lan Q, Rothman N, Zhang Y, Zheng T. Current understanding of lifestyle and environmental factors and risk of non-hodgkin lymphoma: an epidemiological update. J Cancer Epidemiol. 2012;2012: 978930.
Bassig BA, Zheng T, Zhang Y, Berndt SI, Holford TR, Hosgood HD, 3rd, et al. Polymorphisms in complement system genes and risk of non-Hodgkin lymphoma. Environ Mol Mutagen. 2012;53(2):145-51.
Anderson LA, Gadalla S, Morton LM, Landgren O, Pfeiffer R, Warren JL, et al. Population-based study of autoimmune conditions and the risk of specific lymphoid malignancies. Int J Cancer. 2009;125(2): 398-405.
Chen BJ, Chen DY, Kuo CC, Chuang SS. EBV-associated but HHV8-unrelated double-hit effusion-based lymphoma. Diagn Cytopathol. 2017;45(3):257-61.
Foster WR, Bischin A, Dorer R, Aboulafia DM. Human Herpesvirus Type 8-associated Large B-cell Lymphoma: A Nonserous Extracavitary Variant of Primary Effusion Lymphoma in an HIV-infected Man: A Case Report and Review of the Literature. Clin Lymphoma Myeloma Leuk. 2016;16(6):311-21.
Qayyum S, Choi JK. Adult T-cell leukemia/lymphoma. Arch Pathol Lab Med. 2014;138(2):282-6.
Varga C, Holcroft C, Kezouh A, Bucatel S, Johnson N, Petrogiannis-Haliotis T, et al. Comparison of outcomes among patients aged 80 and over and younger patients with diffuse large B-cell lymphoma: a population based study. Leuk Lymphoma. 2014;55(3):533-7.
Hamlin PA, Satram-Hoang S, Reyes C, Hoang KQ, Guduru SR, Skettino S. Treatment patterns and comparative effectiveness in elderly diffuse large B-cell lymphoma patients: A surveillance, epidemiology, and end results-medicare analysis. Oncologist. 2014;19(12):1249-57.
Oluwasola AO, Olaniyi JA, Otegbayo JA, Ogun GO, Akingbola TS, Ukah CO, et al. A fifteen-year review of lymphomas in a Nigerian tertiary healthcare centre. J Health Popul Nutr. 2011;29(4):310-6.
Linet MS, Brown LM, Mbulaiteye SM, Check D, Ostroumova E, Landgren A, et al. International long-term trends and recent patterns in the incidence of leukemias and lymphomas among children and adolescents ages 0-19 years. Int J Cancer. 2016;138(8):1862-74.
Lackowska B, Gruchala A, Jaszcz-Gruchala A, Rolski J, Zemelka T, Danda D, et al. Diagnostic, predictive and prognostic verification of DNA flow cytometric measurements performed at diagnosis for Non-Hodgkin's lymphoma adult patients. Pol J Pathol. 2012;63(1):18-24.
Rogena EA, De Falco G, Schurfeld K, Leoncini L. A review of the trends of lymphomas in the equatorial belt of Africa. Hematol Oncol. 2011;29(3):111-5.
Bateganya MH, Stanaway J, Brentlinger PE, Magaret AS, Wald A, Orem J, et al. Predictors of survival after a diagnosis of non-Hodgkin lymphoma in a resource-limited setting: a retrospective study on the impact of HIV infection and its treatment. J Acquir Immune Defic Syndr. 2011;56(4): 312-9.
Muneishi M, Nakamura A, Tachibana K, Suemitsu J, Hasebe S, Takeuchi K, et al. Retrospective analysis of first-line treatment for follicular lymphoma based on outcomes and medical economics. Int J Clin Oncol. 2018;23(2):375-81.
Hirayama Y, Ishitani K, Ota S, Kurosawa M, Kondo T, Takimoto R, et al. Long-term survey of survival time, histological transformation, and secondary malignancies in Japanese patients with advanced-stage follicular lymphoma in the rituximab era: Hokkaido Hematology Study Group. Int J Hematol. 2014;100(3): 281-9.
Khor S, Beca J, Krahn M, Hodgson D, Lee L, Crump M, et al. Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients: a population-based analysis. BMC Cancer. 2014;14:586.