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Pediatr Blood Cancer. 2017 May;64(5). doi: 10.1002/pbc.26302. Epub 2016 Oct 26.

Hodgkin lymphoma, HIV, and Epstein-Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study.

Author information

1
UNC Project-Malawi, Lilongwe, Malawi.
2
Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
3
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
4
Section of Hematology/Oncology, Texas Children's Hospital, Houston, Texas.
5
Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.
6
Department of Microbiology & Immunology, University of North Carolina, Chapel Hill, North Carolina.
7
Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
8
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.

Abstract

BACKGROUND:

Contemporary descriptions of classical Hodgkin lymphoma (cHL) are lacking from sub-Saharan Africa where human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) are prevalent.

METHODS:

We describe a prospective cHL cohort in Malawi enrolled from 2013 to 2015. Patients received standardized treatment and evaluation, including HIV status and EBV testing of tumors and plasma.

RESULTS:

Among 31 patients with confirmed cHL, the median age was 19 years (range, 2-51 years) and 22 (71%) were male. Sixteen patients (52%) had stage III/IV, 25 (81%) B symptoms, and 16 (52%) performance status impairment. Twenty-three patients (74%) had symptoms >6 months, and 11 of 29 (38%) had received empiric antituberculosis treatment. Anemia was common with median hemoglobin 8.2 g/dL (range, 3.1-17.1 g/dL), which improved during treatment. No children and 5 of 15 adults (33%) were HIV+. All HIV+ patients were on antiretroviral therapy for a median 15 months (range, 2-137 months), with median CD4 count 138 cells/μL (range, 23-329 cells/μL) and four (80%) having undetectable HIV. EBV was present in 18 of 24 (75%) tumor specimens, including 14 of 20 (70%) HIV- and 4 of 4 (100%) HIV+. Baseline plasma EBV DNA was detected in 25 of 28 (89%) patients, with median viral load 4.7 (range, 2.0-6.7) log10 copies/mL, and subsequently declined in most patients. At 12 months, overall survival was 75% (95% confidence interval [CI], 55%-88%) and progression-free survival 65% (95% CI, 42%-81%). Baseline plasma EBV DNA and persistent viremia during treatment were associated with poorer outcomes.

CONCLUSION:

cHL in Malawi is characterized by delayed diagnosis and advanced disease. Most cases were EBV associated and one-third of adults were HIV+. Despite resource limitations, 12-month outcomes were good.

KEYWORDS:

Epstein-Barr virus; Hodgkin lymphoma; Malawi; pediatric cancer; sub-Saharan Africa

PMID:
27781380
PMCID:
PMC5529120
DOI:
10.1002/pbc.26302
[Indexed for MEDLINE]
Free PMC Article

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