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Mature outcomes and prognostic indices in diffuse large B‐cell lymphoma in Malawi: a prospective cohort
Author(s) -
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
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15625
Subject(s) - medicine , diffuse large b cell lymphoma , interquartile range , vincristine , international prognostic index , prednisone , prospective cohort study , chop , performance status , cyclophosphamide , confidence interval , cohort , lymphoma , oncology , gastroenterology , chemotherapy
Summary 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 9 /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.