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.