Clinical presentation and diagnosis of adult patients with non‐Hodgkin lymphoma in Sub‐Saharan Africa

Abstract

SummaryNon‐Hodgkin lymphoma (NHL) is the sixth most common cancer in Sub‐Saharan Africa (SSA). Comprehensive diagnostics of NHL are essential for effective treatment. Our objective was to assess the frequency of NHL subtypes, disease stage and further diagnostic aspects. Eleven population‐based cancer registries in 10 countries participated in our observational study. A random sample of 516 patients was included. Histological confirmation of NHL was available for 76.2% and cytological confirmation for another 17.3%. NHL subclassification was determined in 42.1%. Of these, diffuse large B cell lymphoma, chronic lymphocytic leukaemia and Burkitt lymphoma were the most common subtypes identified (48.8%, 18.4% and 6.0%, respectively). We traced 293 patients, for whom recorded data were amended using clinical records. For these, information on stage, human immunodeficiency virus (HIV) status and Eastern Cooperative Oncology Group Performance Status (ECOG PS) was available for 60.8%, 52.6% and 45.1%, respectively. Stage at diagnosis was advanced for 130 of 178 (73.0%) patients, HIV status was positive for 97 of 154 (63.0%) and ECOG PS was ≥2 for 81 of 132 (61.4%). Knowledge about NHL subclassification and baseline clinical characteristics is crucial for guideline‐recommended treatment. Hence, regionally adapted investments in pathological capacity, as well as standardised clinical diagnostics, will significantly improve the therapeutic precision for NHL in SSA.

Clinical Characteristics and Prognostic Factors of HIV-Positive Patients With Lymphoma in the Poverty Region of China: A Real-World Multicenter Analysis

“…However, infection was not an independent factor for the prediction of death in our present study, relying on the improvement of diagnosis and treatment in recent decades. These clinical characteristics are comparable to many international reports on PLWHIV [2,17].…”

Comparison of baseline lymphoma and HIV characteristics in Malawi before and after implementation of universal antiretroviral therapy

“…The most common lymphoma subtypes identified in our study cohort were DLBCL, low-grade NHL and BL, for both the pre-UART and post-UART periods, consistent with results from a study by Mezger et al [ 40 ] for a sub-Saharan Africa cohort derived from registries across ten countries. The proportion of DLBCL, HL and BL was similar between the pre and post-UART period, for both the full cohort and the subset of PLWH.…”

Global patterns of non‐Hodgkin lymphoma in 2020

“…Previous research has provided substantial evidence linking EBV to the etiology of NHL. [10][11][12][13] The follicular lymphoma, the most frequent indolent lymphoma, is more common in Western countries, whereas T cell lymphoma is more common in East Asian, West African and Caribbean countries, while Burkitt lymphoma is more common in Africa 13,31,32 than elsewhere. HIV infection also plays an important role in the etiology of some NHL types, and where HIV prevalence is high, the burden of NHL tends to be greater.…”

“…37 However, the overall NHL survival, as reported from hospital series from sub-Saharan African countries remains low, 36,38 due to challenges related both to diagnosis and treatment. 32 Advancements in NHL treatments such as stem cell transplantation, immunotherapy and targeted therapies have markedly improved prognosis in recent years in the highest income countries, regardless of clinical stage, increasing 5-year survival to greater than 70%, although this varies by subtype and age. [39][40][41][42] Survival after a lymphoid malignancy diagnosis in middle-income countries appears to be lower, in the range of 30% to 50%, while no population-based on survival data are presently available from low-income countries.…”