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

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 (cyclophosphamid...

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Published inBritish 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
LanguageEnglish
Published England Blackwell Publishing Ltd 01.02.2019
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Online AccessGet full text
ISSN0007-1048
1365-2141
1365-2141
DOI10.1111/bjh.15625

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Abstract 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.
AbstractList 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.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.
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.
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 × 10 9 /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.
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 x 10 9 /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)>2x upper limit of normal (ULN) were associated with mortality. HIV status was not associated with mortality. A simplified prognostic model of LDH>2x 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.
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 × 10 /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.
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.
Author Dhungel, Bal M.
Tomoka, Tamiwe
Mhango, Wilberforce
Kampani, Coxcilly
Kaimila, Bongani
Fedoriw, Yuri
Shea, Thomas C.
Nyirenda, Ruth
Mtangwanika, Asekanadziwa
Mulenga, Maurice
Painschab, Matthew S.
Kasonkanji, Edwards
Gopal, Satish
Chiyoyola, Sarah
Chimzimu, Fred
Zuze, Takondwa
Nyasosela, Richard
Chikasema, Maria
Montgomery, Nathan D.
Krysiak, Robert
Tewete, Blessings
AuthorAffiliation 4 --Kamuzu Central Hospital, Lilongwe, Malawi
3 --University of Malawi College of Medicine, Blantyre, Malawi
2 —University of North Carolina, Chapel Hill, United States of America
1 --UNC Project-Malawi, Lilongwe, Malawi
AuthorAffiliation_xml – name: 1 --UNC Project-Malawi, Lilongwe, Malawi
– name: 3 --University of Malawi College of Medicine, Blantyre, Malawi
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Copyright 2018 British Society for Haematology and John Wiley & Sons Ltd
2018 British Society for Haematology and John Wiley & Sons Ltd.
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Issue 3
Keywords human immunodeficiency virus
sub-Saharan Africa
diffuse large B-cell lymphoma
chemotherapy
prognosis
Language English
License 2018 British Society for Haematology and John Wiley & Sons Ltd.
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Collection and assembly of clinical data: Matthew S. Painschab, Edwards Kasonkanji, Takondwa Zuze, Bongani Kaimila, Richard Nyasosela, Ruth Nyirenda, Maria Chikasema, Blessings Tewete, Asekanadziwa Mtanwanika, Sarah Chiyoyola, Wilberforce Mhango, Robert Krysiak
Conception and design: Satish Gopal and Thomas C. Shea
Accountable for all aspects of the work: All authors
Final approval of manuscript: All authors
Data analysis and interpretation: Matthew S. Painschab, Satish Gopal
AUTHOR CONTRIBUTIONS
Collection and assembly of pathological data: Tamiwe Tomoka, Bal M. Dhungel, Maurice Mulenga, Fred Chimzimu, Coxcilly Kampani, Robert Krysiak, Nathan D. Montgomery, Yuri Fedoriw
Manuscript writing: Matthew S. Painschab, Satish Gopal
ORCID 0000-0003-3780-0207
0000-0001-9175-7436
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Snippet 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...
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...
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...
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StartPage 364
SubjectTerms 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
Title Mature outcomes and prognostic indices in diffuse large B‐cell lymphoma in Malawi: a prospective cohort
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