Hodgkin lymphoma in Africa: Present and future

Stefan, Daniela Cristina

doi:10.1016/j.transci.2013.07.016

Cited by 11 publications

(12 citation statements)

References 14 publications

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“…Randomized clinical trials conducted by cooperative groups in North America and Europe have identified treatment schedules that provide higher efficacy and lower toxicity. However, data about HL in developing countries are scarce and come mostly from retrospective series . These data suggest that there are substantial disparities in healthcare and treatment outcomes for HL patients in large areas of the world.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes for Hodgkin lymphoma: First report from the Brazilian Prospective Registry

Biasoli

Castro

Delamain

et al. 2017

Hematological Oncology

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Data about Hodgkin lymphoma (HL) in developing countries are scarce and suggest the existence of substantial disparities in healthcare and outcomes in large areas of the world. In 2009, a prospective registry of HL was implemented in Brazil. Web-based data were contributed by 20 institutions across the country participating in the Brazilian Prospective Hodgkin's Lymphoma Registry. The aim of this study was to present the clinical features and outcomes of newly diagnosed patients with HL aged 13 to 90 years. Multivariate Cox regression models were used to estimate progression-free (PFS) and overall survival (OS) by clinical factors. A total of 674 patients with classical HL were analysed, with a median follow-up of 37 months. Median age was 30 years (13-90). The median time from the onset of symptoms to diagnosis was 6 months (0-60). Only 6% of patients had early favourable disease, while 65% had advanced disease. Stage IVB was present in 26% and a high-risk International Prognostic Score in 38%. Doxorubicin, bleomycin, vinblastine, and dacarbazine was used in 93%. The median dose of radiotherapy was 36 Gy for localized disease and 32 Gy for advanced disease. The 3 year PFS in early favourable, early unfavourable, and advanced disease were 95%, 88%, and 66%, respectively. High-risk International Prognostic Score, advanced disease, and age greater than or equal to 60 were independently associated with poorer PFS and OS; performance status greater than or equal to 2 was also associated with a poorer OS. Poor-risk patients predominated. Radiation doses for localized disease appear higher than current recommendations. Outcomes appear inferior in developing countries than in developed countries. Delayed diagnosis is probably a major factor underlying these findings. Scattered reports from developing nations suggest that many aspects of standard care in developed countries remain unmet needs for populations living in developing countries. The present report contributes to this body of data, with a proper description of what is currently achieved in urban areas in Brazil.

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Section: Introductionmentioning

confidence: 99%

Treatment outcomes for Hodgkin lymphoma: First report from the Brazilian Prospective Registry

Biasoli

Castro

Delamain

et al. 2017

Hematological Oncology

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Section: Introductionmentioning

confidence: 99%

“…In sub‐Saharan Africa (SSA), classical Hodgkin lymphoma (cHL) is a common malignancy among children and young adults, accounting for 4%–9% of pediatric cancers . Given limited pathology infrastructure, cHL is also likely underreported since gradually progressive lymphadenopathy may be empirically treated as tuberculosis, leading to delayed or missed cHL diagnosis . In resource‐rich countries, 75% of newly diagnosed patients present with early stage I/II cHL, while in resource‐limited countries, more than half of patients present with advanced stage III/IV disease .…”

Section: Introductionmentioning

confidence: 99%

Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study

Westmoreland

Stanley²,

Montgomery

et al. 2016

Pediatric Blood & Cancer

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Background Contemporary descriptions of classical Hodgkin lymphoma (cHL) are lacking from sub-Saharan Africa where human immunodeficiency virus (HIV) and Epstein–Barr virus (EBV) are prevalent. Methods We describe a prospective cHL cohort in Malawi enrolled from 2013 to 2015. Patients received standardized treatment and evaluation, including HIV status and EBV testing of tumors and plasma. Results Among 31 patients with confirmed cHL, the median age was 19 years (range, 2–51 years) and 22 (71%) were male. Sixteen patients (52%) had stage III/IV, 25 (81%) B symptoms, and 16 (52%) performance status impairment. Twenty-three patients (74%) had symptoms >6 months, and 11 of 29 (38%) had received empiric antituberculosis treatment. Anemia was common with median hemoglobin 8.2 g/dL (range, 3.1–17.1 g/dL), which improved during treatment. No children and 5 of 15 adults (33%)were HIV+. All HIV+ patients were on antiretroviral therapy for a median 15 months (range, 2–137 months), with median CD4 count 138 cells/μL (range, 23–329 cells/μL) and four (80%) having undetectable HIV. EBV was present in 18 of 24 (75%) tumor specimens, including 14 of 20 (70%) HIV− and 4 of 4 (100%) HIV+. Baseline plasma EBV DNA was detected in 25 of 28 (89%) patients, with median viral load 4.7 (range, 2.0–6.7) log10copies/mL, and subsequently declined in most patients. At 12 months, overall survival was 75% (95% confidence interval [CI], 55%–88%) and progression-free survival 65% (95% CI, 42%–81%). Baseline plasma EBV DNA and persistent viremia during treatment were associated with poorer outcomes. Conclusion cHL in Malawi is characterized by delayed diagnosis and advanced disease. Most cases were EBV associated and one-third of adults were HIV+. Despite resource limitations, 12-month outcomes were good.

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“…The outcome of Hodgkin's lymphoma (HL) has markedly improved over the past few decades, making HL one of the cancers with the greatest chances of cure . However, data about HL in developing countries are limited and come mostly from retrospective series . These data suggest the existence of substantial disparities in health care and treatment outcomes for HL patients in large areas of the world.…”

mentioning

confidence: 99%

“…1 However, data about HL in developing countries are limited and come mostly from retrospective series. [2][3][4][5][6] These data suggest the existence of substantial disparities in health care and treatment outcomes for HL patients in large areas of the world.…”

mentioning

confidence: 99%

Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients—An analysis from the Brazilian Hodgkin Lymphoma Registry

Biasoli

Castro

Delamain

et al. 2017

Intl Journal of Cancer

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Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78 and 64% (p < 0.0001), respectively. The 3-year overall survival (OS) in higher and lower SES were 94 and 82% (p < 0.0001), respectively. Lower SES patients were more likely to be ≥ 60 years (16 vs. 8%, p = 0.003), and to present higher risk International Prognostic score (IPS) (44 vs. 31%, p = 0.004) and advanced disease (71 vs. 58%, p = 0.003). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR = 3.12 [1.86-5.22] for OS and HR = 1.66 [1.19-2.32] for PFS). The fatality ratio during treatment was 7.5 and 1.3% for lower and higher SES (p = 0.0001). Infections and treatment toxicity accounted for 81% of these deaths. SES is an independent factor associated with shorter survival in HL in Brazil. Potential underlying mechanisms associated with the impact of SES are delayed diagnosis and poorer education. Educational and socio-economic support interventions must be tested in this vulnerable population.

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Hodgkin lymphoma in Africa: Present and future

Cited by 11 publications

References 14 publications

Treatment outcomes for Hodgkin lymphoma: First report from the Brazilian Prospective Registry

Treatment outcomes for Hodgkin lymphoma: First report from the Brazilian Prospective Registry

Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study

Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients—An analysis from the Brazilian Hodgkin Lymphoma Registry

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