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. 2020 Jan;9(1):77-83.
doi: 10.1002/cam4.2631. Epub 2019 Nov 9.

Modified EPOCH for high-risk non-Hodgkin lymphoma in sub-Saharan Africa

Takondwa Zuze  1 , Grace K Ellis  1 , Edwards Kasonkanji  1 , Bongani Kaimila  1   2 , Richard Nyasosela  3 , Ruth Nyirenda  3 , Tamiwe Tomoka  1   2   4 , Maurice Mulenga  3 , Maria Chikasema  1 , Blessings Tewete  1 , Asekanadziwa Mtangwanika  1 , Sarah Chiyoyola  1 , Fred Chimzimu  1 , Coxcilly Kampani  1 , Wilberforce Mhango  1 , Simon Nicholas  1 , Cara Randall  4 , Nathan D Montgomery  4 , George Fedoriw  4 , Katherine D Westmoreland  1   4 , Matthew S Painschab  1   4 , Satish Gopal  1   2   4
Affiliations

Modified EPOCH for high-risk non-Hodgkin lymphoma in sub-Saharan Africa

Takondwa Zuze et al. Cancer Med. 2020 Jan.

Abstract

Aggressive non-Hodgkin lymphoma (NHL) is among the most common cancers in sub-Saharan Africa (SSA), where CHOP is standard treatment and outcomes are poor. To address this, we treated 17 newly diagnosed adult patients in Malawi with Burkitt (n = 8), plasmablastic (n = 8), and primary effusion lymphoma (n = 1) with a modified EPOCH regimen between 2016 and 2019. Twelve patients (71%) were male and the median age was 40 years (range 16-63). Eleven (65%) were HIV infected, median CD4 count was 218 cells/µL (range 9-460), and nine (82%) had suppressed HIV RNA < 400 copies/mL. Patients received a median of six cycles (range 2-8) and median follow-up was 14 months (range 2-34) among patients still alive. Grade 3/4 neutropenia was observed in 26% of cycles and in 65% of patients. Sixteen (94%) responded to EPOCH and 10 (59%) achieved a complete response. One-year overall survival (OS) was 62% (95% confidence interval [CI], 42%-91%). Five patients (29%) died from progressive NHL and three (18%) from treatment-related complications. These data suggest EPOCH with setting-appropriate modifications may be a practical, safe, and effective option for improving high-risk NHL outcomes in Malawi and comparable settings, which deserves further prospective evaluation.

Keywords: global health; modified EPOCH; non-Hodgkin lymphoma; sub-Saharan Africa.

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Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1
Mean absolute neutrophil count during modified EPOCH in Lilongwe, Malawi
Figure 2
Figure 2
A, Overall survival. B, Progression‐free survival. Kaplan‐Meier survival estimates with 95% confidence intervals among patients receiving modified EPOCH in Lilongwe, Malawi
See this image and copyright information in PMC

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