Lymphomas in sub‐Saharan Africa – what can we learn and how can we help in improving diagnosis, managing patients and fostering translational research?

Abstract

Approximately 30,000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team of lymphoma experts on159 fine needle aspirationsamples and 467 histological samples during their visit to the African centres is presented. Among children (<18 years of age), BL accounted for 82% of all NHL, and among adults, diffuse large B-cell lymphoma accounted for 55% of all NHLs. Among adults, various lymphomas other than BL, including T-cell lymphomas, were encountered. The review also discusses the current strategies of the International Network of Cancer Treatment and Research on improving the diagnostic standards and management of lymphoma patients and in acquiring reliable clinical and pathology data in sub-Saharan Africa for fostering high-quality translational research.

Targetable subsets of non-Hodgkin lymphoma in Malawi define therapeutic opportunities

“…4 Although chemotherapy regimens for aggressive B-cell lymphomas in Malawi do not mirror HIC protocols, in part due to a lack of sufficient supportive care, BL and non-BL aggressive NHL are nonetheless differentially treated in Malawi, and therefore, accurate segregation of these diagnoses is immediately relevant. 10,11 Unsupervised hierarchical clustering using a 21-gene NanoString-based classifier previously only applied to Western cohorts 17 had a diagnostic accuracy for DLBCL and BL of 96% and 88%, respectively, in our cohort.…”

“…Of those 326 cases, 280 (86%) were confirmed as NHL at BWH by immunophenotypic analysis (Table 1), a concordance rate similar to prior reports. 4 The remaining 14% were neuroendocrine tumor (n 5 20), T-lymphoblastic lymphoma (8), carcinoma, not otherwise specified (8), CHL (4), myeloid sarcoma (2), plasmacytoma (2), nasopharyngeal carcinoma (1), and reactive (1). As previously reported, there was a striking paucity of mature T-cell neoplasms (1 peripheral T-cell lymphoma not otherwise specified, 2 ALKpositive anaplastic large cell lymphoma) 4 and very few low-grade lymphomas ( Table 1).…”

“…3 Immunohistochemistry, fluorescence in situ hybridization (FISH), and molecular assay capabilities are almost completely absent from SSA. 4 Additionally, most SSA countries employ ,1 pathologist per 500 000 people, which is approximately one-tenth the rate in HICs. 5 This lack of comprehensive NHL subtyping derives partially from the fact that NHL-related therapeutic interventions are scarce in many SSA countries and treatment with high-dose chemotherapy is impractical due to significant limitations in supportive care; thus, the clinical pressure to fully classify NHLs is greatly diminished compared with HICs.…”

Issues of management and monitoring by laboratory methods in respiratory medicine: editorial introduction

“…simple immunohistochemistry (IHC). [1][2][3] The implication is that the concept of disease management and monitoring by laboratory methods is well acknowledged, but the practice is often shrouded in debate of to test or not to test. 4 Unarguably, respiratory diseases encompass some of the communicable and non-communicable leading causes of death worldwide; while industrialization is enhancing the phenomenon of increased risk, especially in urban areas.…”

Celebrating treatment completion in sub-Saharan Africa

“…Despite much effort-which include patient-centred counselling, 2 fee coverage, 3 attentiveness to nutritional status, 4 social support, 5 infrastructure develop ments, 6 gradual adaptation of treatment regimens with decreased toxicity, 7,8 and collabor ative partnerships 9 -the rates of treatment completion remain low, with reported abandonment rates of 40-50%. [10][11][12][13] I recently visited a twinning site in sub-Saharan Africa on the day of a patient's treatment completion.…”