Mature outcomes and prognostic indices in diffuse large B‐cell lymphoma in Malawi: a prospective cohort

• Published in: British journal of haematology Vol. 184; no. 3; pp. 364 - 372
• Main Authors: Painschab, Matthew S., Kasonkanji, Edwards, Zuze, Takondwa, Kaimila, Bongani, Tomoka, Tamiwe, Nyasosela, Richard, Nyirenda, Ruth, Dhungel, Bal M., Mulenga, Maurice, Chikasema, Maria, Tewete, Blessings, Mtangwanika, Asekanadziwa, Chiyoyola, Sarah, Mhango, Wilberforce, Chimzimu, Fred, Kampani, Coxcilly, Krysiak, Robert, Shea, Thomas C., Montgomery, Nathan D., Fedoriw, Yuri, Gopal, Satish
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.02.2019
• Subjects: Adult; Aged; Anti-Retroviral Agents - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antiretroviral therapy; B-cell lymphoma; CD4 antigen; Chemotherapy; Cyclophosphamide; Cyclophosphamide - administration & dosage; diffuse large B‐cell lymphoma; Disease-Free Survival; Doxorubicin; Doxorubicin - administration & dosage; Hematology; HIV; HIV Seropositivity - diagnosis; HIV Seropositivity - drug therapy; HIV Seropositivity - mortality; HIV-1; Human immunodeficiency virus; Humans; L-Lactate dehydrogenase; Lactic acid; Lymphocytes B; Lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - mortality; Malawi - epidemiology; Middle Aged; Mortality; Oncology; Prednisone; Prednisone - administration & dosage; prognosis; Prospective Studies; sub‐Saharan Africa; Survival Rate; Vincristine; Vincristine - administration & dosage; Malawi; human immunodeficiency virus; sub-Saharan Africa; diffuse large B-cell lymphoma; chemotherapy; prognosis
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/bjh.15625

Summary Outcomes for diffuse large B‐cell lymphoma (DLBCL) in sub‐Saharan Africa (SSA) are poorly described. We report mature data from one of the first prospective SSA cohorts. Patients aged ≥18 years with DLBCL were enrolled in Malawi 2013–2017. Participants were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy and concurrent antiretroviral therapy (ART) if positive for human immunodeficiency virus (HIV+). Eighty‐six participants (mean age 47 years, standard deviation 13) were enrolled: 54 (63%) were male and 51 (59%) were HIV+, of whom 34 (67%) were on ART at DLBCL diagnosis. Median CD4 count was 0·113 cells × 109/l (interquartile range [IQR] 0·062–0·227) and 25 (49%) had HIV viral load <400 copies/μl. Participants received median six cycles CHOP (IQR 4–6). No patients were lost to follow‐up and the 2‐year overall survival was 38% (95% confidence interval 28–49). In multivariable analyses, Eastern Cooperative Oncology Group performance status (PS) ≥2 and lactate dehydrogenase (LDH) >2× upper limit of normal (ULN) were associated with mortality. HIV status was not associated with mortality. A simplified prognostic model of LDH >2× ULN and PS ≥2 performed at least as well as the age‐adjusted International Prognostic Index. DLBCL can be successfully treated in SSA and outcomes did not differ by HIV status. A simplified prognostic model prognosticates well and may be easier to use in resource‐limited settings but requires validation.