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

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• Alternative Title:
  Br J Haematol
• Personal Author:
  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
• Description:
  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.
• Subjects:
  Adult Aged Anti-Retroviral Agents Antineoplastic Combined Chemotherapy Protocols Cyclophosphamide Disease-Free Survival Doxorubicin HIV-1 HIV Seropositivity Humans Lymphoma, Large B-Cell, Diffuse Malawi Middle Aged Prednisone Prospective Studies Survival Rate Vincristine

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• Keywords:
  Chemotherapy DLBCL HIV Prognosis Sub-Saharan Africa
• Source:
  Br J Haematol. 184(3):364-372
• Pubmed ID:
  30450671
• Pubmed Central ID:
  PMC6340743
• Document Type:
  Journal Article
• Funding:
  K01 TW009488/TW/FIC NIH HHSUnited States/ ; U54 CA190152/CA/NCI NIH HHSUnited States/ ; P20 CA210285/CA/NCI NIH HHSUnited States/ ; P30 CA016086/CA/NCI NIH HHSUnited States/ ; L30 CA233709/CA/NCI NIH HHSUnited States/ ; UM1 CA121947/CA/NCI NIH HHSUnited States/ ; R21 CA180815/CA/NCI NIH HHSUnited States/ ; U01 CA121947/CA/NCI NIH HHSUnited States/ ; D43 TW009340/TW/FIC NIH HHSUnited States/
• Volume:
  184
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:96facb6f8564744a40c3a8113e655ec944c78a2a69399e6d93a81e6a5b317deb
• Download URL:
  https://stacks.cdc.gov/view/cdc/62373/cdc_62373_DS1.pdf
• File Type:
  [PDF - 680.80 KB ]