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Observational Study
. 2019 Feb;184(3):364-372.
doi: 10.1111/bjh.15625. Epub 2018 Nov 18.

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

Matthew S Painschab  1   2 , Edwards Kasonkanji  1 , Takondwa Zuze  1 , Bongani Kaimila  1 , Tamiwe Tomoka  1   3 , Richard Nyasosela  4 , Ruth Nyirenda  4 , Bal M Dhungel  1   2   4 , Maurice Mulenga  4 , Maria Chikasema  1 , Blessings Tewete  1 , Asekanadziwa Mtangwanika  1 , Sarah Chiyoyola  1 , Wilberforce Mhango  1 , Fred Chimzimu  1 , Coxcilly Kampani  1 , Robert Krysiak  1 , Thomas C Shea  2 , Nathan D Montgomery  2 , Yuri Fedoriw  2 , Satish Gopal  1   2   3
Affiliations
Observational Study

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

Matthew S Painschab et al. Br J Haematol. 2019 Feb.

Abstract

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.

Keywords: chemotherapy; diffuse large B-cell lymphoma; human immunodeficiency virus; prognosis; sub-Saharan Africa.

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Conflict of interest statement

AUTHORS DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

None of the authors have any have conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Overall survival and progression-free survival for diffuse large B-cell lymphoma in Malawi.
(A) Overall survival in overall cohort with 95% confidence intervals. (B) Overall survival by human immunodeficiency virus (HIV) status. (C) Progression-free survival in overall cohort with 95% confidence intervals. (D) Progression-free survival by HIV status.
Figure 2.
Figure 2.. Prognostic models for overall survival of patients with diffuse large B-cell lymphoma in Malawi.
(A) Age-adjusted international prognostic index: sum of LDH>ULN + Ann Arbor stage >2 + ECOG PS ≥2. (B) Age-adjusted international prognostic index using LDH>2x ULN: sum of LDH>2x ULN + Ann Arbor stage >2 + ECOG PS ≥2. (C) Simplified prognostic index of sum of LDH>2x ULN + ECOG PS ≥2. AIC=Akaike Information Criterion; ECOG PS=Eastern Cooperative Oncology Group performance status; LDH=lactate dehydrogenase, ULN=upper limit of normal.
See this image and copyright information in PMC

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