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. 2024 Feb 8:69:102480.
doi: 10.1016/j.eclinm.2024.102480. eCollection 2024 Mar.

Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort study

Marriam Mponda  1 , Evaristar Kudowa  1 , Dalton M Craven  1 , Luke C Eastburg  1   2 , Maria Chikasema  1 , Edwards Kasonkanji  1 , Tamiwe Tomoka  1 , Sophie Maharry Roush  2 , Lusayo Simwinga  1 , Noel Mumba  1 , Satish Gopal  3 , Yuri Fedoriw  1   4 , Matthew S Painschab  1   2   4
Affiliations

Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort study

Marriam Mponda et al. EClinicalMedicine. .

Abstract

Background: ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) is a proven, curative regimen for Hodgkin lymphoma (HL). Prospective data describing HL treatment in sub-Saharan Africa are limited. We aimed to fill this knowledge gap, using data from Malawi.

Methods: We report a prospective observational cohort of HL (aged ≥ 15) from a single, tertiary referral centre in Malawi. We enrolled patients with pathologicially confirmed Hodgkin lymphoma between June 1, 2013, and Dec 31, 2021 with follow-up censored on May 31, 2022. Patients were treated with ABVD and concurrent antiretroviral therapy if HIV-positive and were followed up for 5 years. The primary outcome was overall survival; secondary outcomes included progression-free survival, response assessment, and adverse events. Microcosting of HL diagnosis, treatment, and follow-up was embedded.

Findings: We enrolled 38 patients with a median age of 27 years (interquartile range 19-46); eleven (28%) were HIV-positive. Of 35 patients treated with ABVD, 24 (71%) had stage III/IV, nine (26%) unfavourable limited stage, and two (6%) favourable limited stage. Among HIV-infected individuals, mean CD4 count at HL diagnosis was 179 cells/uL and ten (91%) had HIV RNA < 400 copies/mL. Grade 3/4 neutropenia occurred in 24 (68%) patients and caused treatment delay in 16 (46%). Of ten deaths, seven were due to HL, two possible treatment-related toxicity, and one uncertain. 2-year overall survival was 82% (95% CI 70-96%) and 2-year progression-free survival was 64% (95% CI 50-83%). PFS appeared better for HIV-positive patients (HR 0.23 (95% CI 0.05-1.02)) after controlling for stage and performance status (p = 0.05). We estimated $2708 (2022 USD) for HL diagnosis, treatment, and follow-up in our cohort.

Interpretation: Our findings suggest that treatment with ABVD is safe, efficacious, and affordable for HL in Malawi. Outcomes are worse than in high-income countries due to HL progression. Future studies are needed to understand outcome inequities and to assess efficacy of therapies for patients with relapsed or refractory HL in Malawi.

Funding: National Institutes of Health, Lineberger Comprehensive Cancer Center.

Keywords: ABVD; Cost; HIV; Hodgkin lymphoma; Microcosting; Sub-Saharan Africa.

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Conflict of interest statement

We declare no competing interests. This work was completed while Dr. Satish Gopal was employed at the University of North Carolina at Chapel Hill. The opinions expressed in this article are the authors own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States Government.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for overall survival (OS) and progression-free survival (PFS). OS curves shown for entire cohort (A), by HIV status (B), and by advanced stage, favourable and unfavourable risk (C). PFS curves shown for entire cohort (D), by HIV status (E), and by advanced stage, favourable and unfavourable risk (F).
Fig. 2
Fig. 2
Micro-costing analysis of cancer care for patients with Hodgkin lymphoma. Data are shown as cost estimates on a per-patient basis for treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) (column A) and best supportive care only (column B). Percentages of different costs are displayed and categories of costs are color coded.
See this image and copyright information in PMC

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