Immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients, Kampala, Uganda

Abstract

BackgroundNon Hodgkin lymphomas are the most common lymphomas in Uganda. Recent studies from developed countries have shown differences in survival for the different immunophenotypes. Such studies are lacking in Africa where diagnosis is largely dependent on morphology alone. We report immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients in Kampala, Uganda.MethodsNon Hodgkin lymphoma tissue blocks from the archives of the Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda, from 1991-2000, were sub typed using haematoxylin and eosin, Giemsa as well as immunohistochemistry. Using tissue micro array, 119 biopsies were subjected to: CD3, CD5, CD10, CD20, CD23, CD30, CD38, CD79a, CD138, Bcl-6, Bcl-2, IRTA-1, MUM1/IRF4, Bcl-1/cyclin D1, TdT, ALKc, and Ki-67/Mib1. Case notes were retrieved for: disease stage, chemotherapy courses received and retrospective follow up was done for survival.ResultsNon Hodgkin B cell lymphomas comprised of Burkitt lymphoma [BL] (95/119) diffuse large B cell lymphoma (19/119), mantle cell lymphoma (4/119) and precursor B lymphoblastic lymphoma (1/119).For Burkitt lymphoma, good prognosis was associated with receiving chemotherapy, female gender and CD30 positivity. Only receiving chemotherapy remained significant after Cox regression analysis. Diffuse large B cell lymphomas with activated germinal centre B cell (GCB) pattern (CD10+/-, BCL-6+/-, MUM+/-, CD138+/-) had better survival (98.4 months; 95% CI 89.5 -107.3) than the others (57.3 months; 95% CI 35.5 - 79.0) p = 0.027 (log rank test).ConclusionsActivated GCB diffuse large B cell lymphoma had a better prognosis than the others. For Burkitt lymphoma, not receiving chemotherapy carried a poor prognosis. Availability of chemotherapy in this resource limited setting is critical for survival of lymphoma patients.

Predictors of Survival After a Diagnosis of Non-Hodgkin Lymphoma in a Resource-Limited Setting: A Retrospective Study on the Impact of HIV Infection and Its Treatment

“…In resource-rich settings, these have included the tumor stage, bulk and histopathologic type, age, serum lactate dehydrogenase (LDH) level, performance status, and the number of nodal and extra nodal sites involved 12–14. Receipt of both chemotherapy and supportive therapy (e.g., Granulocyte colony-stimulating factor, G-CSF) has also influenced treatment outcomes 15–17.…”

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

“…Diffuse large B‐cell lymphoma (DLBCL) is the commonest NHL subtype in SSA, as in other parts of the world (Naresh et al , ). Previous reports from SSA have largely consisted of retrospective studies with non‐standardized patient evaluation and treatment, and high loss to follow‐up (Wood et al , ; Mwanda et al , ; Tumwine et al , ; Bateganya et al , ; de Witt et al , ; Sissolak et al , ; Milligan et al , ).…”

Large Cell Lymphoma: Correlation of HIV Status and Prognosis with Differentiation Profiles Assessed by Immunophenotyping

“…52 In contrast, Tumwine et al 62 found that activated germinal center DLBCL, defined as those expressing CD10, Bcl-6, MUM1 and CD138, was associated with superior survival outcome. In the present study, statistic observation revealed that CD138 expression in >25% of tumour cells (score ≥2), occurred only in the HIV positive group and was associated with shorter survival time.…”

“…53 The common morphologic variants of DLBCL include centroblastic, immunoblastic and anaplastic variants. Chang et al, 59 Madan et al 60 found that the immunophenotype in AIDS-related It is noteworthy that in one of few studies to emerge from Africa, specifically Uganda, Tumwine et al 62 established that the activated germinal center-type DLBCL, defined as those expressing CD10, Bcl-6, MUM1 and CD138, was found to have the best prognosis relative to other groups of DLBCL in their study.…”