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

Details

• Alternative Title:
  Pediatr Blood Cancer
• Personal Author:
  Westmoreland, Katherine D. ; Stanley, Christopher C. ; Montgomery, Nathan D. ; Kaimila, Bongani ; Kasonkanji, Edwards ; El-Mallawany, Nader Kim ; Wasswa, Peter ; Mtete, Idah ; Butia, Mercy ; Itimu, Salama ; Chasela, Mary ; Mtunda, Mary ; Chikasema, Maria ; Makwakwa, Victor ; Kampani, Coxcilly ; Dhungel, Bal M. ; Sanders, Marcia K. ; Krysiak, Robert ; Tomoka, Tamiwe ; Liomba, N. George ; Dittmer, Dirk P. ; Fedoriw, Yuri ; Gopal, Satish
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• Description:
  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.
• Subjects:
  • Adolescent
  • Adult
  • CD4 Lymphocyte Count
  • Child
  • Child, Preschool
  • DNA, Viral
  • Disease-Free Survival
  • Epstein-Barr Virus Infections
  • Female
  • HIV Infections
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• Keywords:
  • Epstein–Barr virus
  • Hodgkin lymphoma
  • Malawi
  • pediatric cancer
  • sub-Saharan Africa
• Source:
  Pediatr Blood Cancer. 64(5)
• Pubmed ID:
  27781380
• Pubmed Central ID:
  PMC5529120
• Document Type:
  Journal Article
• Funding:
  K01 TW009488/TW/FIC NIH HHSUnited States/ ; P20 CA210285/CA/NCI NIH HHSUnited States/ ; P30 CA016086/CA/NCI NIH HHSUnited States/ ; U2G PS001965/PS/NCHHSTP CDC HHSUnited States/ ; U01 CA121947/CA/NCI NIH HHSUnited States/ ; P01 CA019014/CA/NCI NIH HHSUnited States/ ; R21 CA180097/CA/NCI NIH HHSUnited States/ ; U54 CA190152/CA/NCI NIH HHSUnited States/ ; R25 TW009340/TW/FIC NIH HHSUnited States/ ; P30 AI050410/AI/NIAID NIH HHSUnited States/ ; R21 CA180815/CA/NCI NIH HHSUnited States/
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• Volume:
  64
• Issue:
  5
• Download URL:
  https://stacks.cdc.gov/view/cdc/47212/cdc_47212_DS1.pdf
• File Type:
  [PDF - 590.29 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d4e81e3412af6aa87b01785a967b0f46cb61d34727078ff98dbb60a7e9a525b0