Presenting features and treatment outcomes of chronic lymphocytic leukaemia in a resource poor Southern Nigeria

BackgroundChronic lymphocytic leukaemia is a relatively common haematological malignancy affecting older adults, accounting for about 20% of haematological malignancies in Nigeria. Diagnosis of this disease depends on the demonstration of clonal lymphocytosis > 5 x 109/L with a characteristic immunophenotypic pattern amidst other clinical and laboratory features.ObjectivesTo determine the predominant clinical and laboratory features of CLL at presentation and their relationship with patient survival. This study also aims at examining the relationship between treatment protocol and outcome.Methods: This is a retrospective study with 8 years data (2010-2018)collected from four different centers. Data was analyzed using SPSS 20.0.ResultsThere were a total of 97 cases, with a male: female ratio of 1.1:1. The median age at presentation was 59 years. Approximately 55% of the patients presented at Binet stage C, with splenomegaly in 93.2% and 78% were anaemic. The mean white cell count was 137.9 ± 14.7 x 109/L, with a median absolute lymphocyte count of 86 x 109/L. The commonest treatment regimen was chlorambucil and prednisolone and males had a superior response. The number of chemotherapy cycles, serum alkaline phosphatase and aspartate transaminase correlated positively with duration of survival. Mortality rate over the five year period was 14.3%.ConclusionCLL was found to present in younger patients when compared to previous studies with a median age of 57 years at diagnosis. Our study showed a slight female preponderance and better response to therapy in males. Majority of the patients presented in Binet stage C and were treated with chlorambucil-based drug combinations compared to more current treatment with Fludarabine-based combinations. A high serum alanine transaminase and alkaline phosphatase was found to positively correlate with survival amongst this patient populatio

Comparison of absolute neutrophil to CD4 lymphocyte values as a marker of immunosuppression in cancer patients on cytotoxic chemotherapy

Background: The absolute neutrophil count (ANC) is currently used to assess immune status of patients on cytotoxic therapy. The CD4 lymphocytes have also been shown to be of importance in protection against opportunistic infections. In people of African descent a low baseline ANC has been recorded and the currently accepted neutropaenic threshold may not be appropriate. Objective: This study was aimed at comparing the change in ANC to CD4 lymphocyte count in adult cancer patients following chemotherapy. Patients and Methods: Eighty chemotherapy-naive patients with various malignancies had their ANC and CD4 lymphocyte counts done at days 0 and 12 of the first cycle of various chemotherapeutic regimens. The paired sample t-test was done to assess the significance between these values. Socio-demographic data was obtained using questionnaires. Results: ANC and CD4 pre-chemotherapy differed significantly from their post-chemotherapy values (p=0.001) for both parameters). The CD4 count showed significant reduction in patients with Non-Hodgkin\u2019s lymphoma (p=0.043), colorectal carcinoma (p=0.037) and other malignancies (p=0.030), while the ANC did not. Patients who had received COPP for Hodgkin\u2019s lymphoma also had significant CD4 depletion (p=0.037). Conclusion: The CD4 lymphocyte count may be a more suitable parameter than ANC, for monitoring immuno-depletion in cancer patients on cytotoxic chemotherapy. Further studies are required to validate these findings, especially in the Negroi

Multiple myeloma in Nigeria: a multi-centre epidemiological and biomedical study

Introduction: Myelomatosis is a malignant proliferation of plasma cells in the bone marrow, with  relatively high prevalence in African populations. Variation in genetic mutations has been observed in individual patients and may be responsible for differences in disease pattern and treatment outcomes. This study described the presentations and treatment outcomes of multiple myeloma in nigerian. Methods: The data was obtained retrospectively from the case notes of 135 patients diagnosed with multiple myeloma from eight tertiary health institutions across the six geopolitical zones of Nigeria from 2005 to 2014. Data analysis was carried out using SPSS 17.0.Results: The predominant presentations were bone pain in 97 (74%), nephropathy in 47 (35.9%) and pathological fractures in 58 (44.3%). Sixty-seven percent (67%) of the patients were less than 60 years, and 35% had Bence Jones proteinuria. The overall survival beyond 6 months was 91.3%, mean duration of survival rate was 7.4 months. Majority (66.2%) were on Melphalan alone or on melphalan-containing combinations. A higher packed cell volume (PCV) and total serum protein levels at presentation were associated with increased survival, p=0.033 and 0.036, respectively.Conclusion: This study portrayed the importance of detail investigation on the causes of bone pain and anaemia in person's aged 40 years and above. There is a high prevalence of nephropathy in this cohort of patients which needs to be further investigated. Majority of the patients, though < 65 years of age were placed on melphalan-containing combinations, which foreclosed chances of future autologous bone marrow transplantation.Key words: Multiple myeloma, Nigeria, presentation, treatment modalitie

Effectiveness of blood utilization across departments in a tertiary health institution

Intruduction: The limited availability of blood makes it imperative that Hospitals and transfusion centres employ blood utilization indicators to ensure effective and efficient use. This study is a review of the transfusion practices and blood utilization Indicators of the largest tertiary health centre in South East Nigeria. Material and methods: The study is a retrospective cross-sectional Hospital based type. The following, biodemographic data, clinical diagnosis, and blood bank information such as patient and donor blood types from a 3-year period (January 2018–January 2021) was reviewed. The total number of units crossmatched, issued, transfused, or returned was extracted. Utilization Indicators such as crossmatch to transfusion ratio, transfusion probability, and transfusion index were calculated and our findings were compared to similar studies performed in centres located in India, Ethiopia and Saudi Arabia Results: A total of 2,919 blood units were cross-matched out of which 2,212 units were transfused to 1,953 patients. The study reported an overall crossmatch to transfusion rate of 1.3, a Transfusion probability of 71%, and a transfusion index of 1.1. These findings compare favourably with findings reported from studies done in other LMIC countries. Comparatively, the Department of Medicine with a crossmatch to transfusion ratio of 1.1 has the most efficient blood ordering practices. Conclusion: The study findings showed that the quality indicators on the utilization of blood are in keeping with international best practices. Implementation of policies like the Maximum surgical blood ordering schedule (MSBOS) could further strengthen the practice and improve the results of the surgical disciplines

Is renal medullary carcinoma the seventh nephropathy in sickle cell disease? A multi-center Nigerian survey

Introduction: Previous studies had enlisted renal medullary carcinoma (RMC) as the seventh nephropathy in sickle cell disease (SCD). Clinical experience has contradicted this claim and this study is targeted at refuting or supporting this assumption.Objective: To estimate the prevalence of RMC and describe other renal complications in SCD.Materials and methods: 14 physicians (haematologists and urologists) in 11 tertiary institutions across the country were collated from patients’ case notes and hospital SCD registers.Results: Of the 3,596 registered sickle patients, 2 (0.056%) had been diagnosed with RMC over a ten year period, thereby giving an estimated prevalence rate of 5.6 per 100,000. The most common renal complication reported by the attending physicians was chronic kidney disease (CKD). The frequency of routine renal screening for SCD patients varied widely between centres – most were done at diagnosis, annually or bi-annually.Conclusion: The ten year prevalence of RMC in Nigerian SCD patients was determined to be 5.6 (estimated incidence of 0.56). RMC is not more common in SCD patients and therefore cannot be regarded as a “Seventh Sickle nephropathy”. Most of the managing physicians reported that the commonest nephropathy observed in their SCD patients was chronic kidney disease.Keywords: Renal medullary carcinoma, seventh nephropathy, sickle cell disease, Nigerian surve

Is renal medullary carcinoma the seventh nephropathy in sickle cell disease? A multi-center Nigerian survey.

Introduction: Previous studies had enlisted renal medullary carcinoma (RMC) as the seventh nephropathy in sickle cell disease (SCD). Clinical experience has contradicted this claim and this study is targeted at refuting or supporting this assumption. Objective: To estimate the prevalence of RMC and describe other renal complications in SCD. Materials and methods: 14 physicians (haematologists and urologists) in 11 tertiary institutions across the country were collated from patients\u2019 case notes and hospital SCD registers. Results: Of the 3,596 registered sickle patients, 2 (0.056%) had been diagnosed with RMC over a ten year period, thereby giving an estimated prevalence rate of 5.6 per 100,000. The most common renal complication reported by the attending physicians was chronic kidney disease (CKD). The frequency of routine renal screening for SCD patients varied widely between centres \u2013 most were done at diagnosis, annually or bi-annually. Conclusion: The ten year prevalence of RMC in Nigerian SCD patients was determined to be 5.6 (estimated incidence of 0.56). RMC is not more common in SCD patients and therefore cannot be regarded as a \u201cSeventh Sickle nephropathy\u201d. Most of the managing physicians reported that the commonest nephropathy observed in their SCD patients was chronic kidney disease

Blood transfusion in Sub-Saharan Africa: Historical perspective, clinical drivers of demand and strategies for increasing availability

Several decades after the World Health Assembly gave a declaration that every nation should adopt the use of voluntary non-remunerated blood donors (VNRD), operate a centralised system of blood collection, screening and transportation, many countries in Africa are still practicing hospital-based blood transfusion services. They also recruit family replacement blood donors and paid donors known to be less safe than the VNRD. Although in the early 2000s, there was noticeable improvement in blood testing and preservation. This positive effect was as a result of foreign aid from World Health Organization (WHO), President’s Emergency Plan for AIDS Relief (PEPFAR) and other external funding, but the gains were quickly lost as soon as the funds were withdrawn. In order to achieve a sustainable and safe blood transfusion in Africa, blood transfusion guidelines should be implemented. This review examines the history of transfusion in Africa and the strategies to increase blood availability in Sub-Saharan Africa. French title: La transfusion sanguine en Afrique subsaharienne : perspective historique, motifs cliniques de la demande et stratégies d'augmentation de la disponibilité Plusieurs décennies après que l'Assemblée de l’Organisation Mondiale de la Santé a déclaré que chaque nation devrait adopter le don de sang volontaire non rémunéré (VNRD), utiliser un système centralisé de collecte, de dépistage et de transport du sang, de nombreux pays d'Afrique pratiquent encore la transfusion dans les services hospitaliers. Ils recrutent également des donneurs de sang de remplacement familiaux et des donneurs rémunérés connus moins sûrs que le VNRD. Cependant, au début des années 2000, il y a eu une amélioration notable des dépistages infectieux et de la conservation. Cet effet positif était le résultat de l'aide étrangère de l'Organisation mondiale de la santé (OMS), du President’s Emergency Plan for AIDS Relief (PEPFAR) et d'autres financements externes, mais les gains ont été rapidement perdus dès que les fonds ont été retirés. Afin de parvenir à une transfusion sanguine durable et sûre en Afrique, des directives sur la transfusion sanguine doivent être mises en œuvre. Cette revue examine l'histoire de la transfusion en Afrique et les stratégies pour augmenter la disponibilité du sang en Afrique subsaharienne

Bortezomib Prescription Pattern for the Treatment of Multiple Myeloma by Hematologists in Nigeria

Purpose: Novel therapy has dramatically changed the outcome of patients with myeloma. Current National Comprehensive Cancer Network guidelines give bortezomib-based combinations a central role in the management of multiple myeloma (MM). The aim of this survey is to assess the use of bortezomib for the treatment of MM by hematologists practicing in Nigeria. Materials and Methods: This is a cross-sectional observational survey. A structured, prevalidated questionnaire was self-administered to different cadres of hematologists. Data collected were analyzed using SPSS software version 21 (IBM, Chicago, IL). Results: There were 54 respondents from 24 centers across the country. The most frequently used drugs for first-line therapy were thalidomide (66.7%), dexamethasone (54.2%), and bortezomib (48%), and a combination of bortezomib, thalidomide, and dexamethasone (16.7%) was the most frequently used first-line regimen. Of the 54 hematologists, 39 (72.2%) had prescribed bortezomib previously; no one had used bortezomib as monotherapy. Drug unavailability (86.7%) and cost (46.7%) were the major reasons for those who had not prescribed bortezomib. Approximately 56.4% of responders had patients who had experienced adverse effects, of which neuropathy was the most common (86.3%). Conclusion: Bortezomib, thalidomide, and dexamethasone was the most frequently used first-line regimen to treat myelomatosis. Thalidomide and dexamethasone were the most frequently used drugs in myeloma treatment. Despite poor access to health care, coupled with the high cost and poor availability of bortezomib in our low- or middle-income country, those who prescribed bortezomib did so frequently (in more than half of their patients)

Correlates of neutrophil/lymphocyte, platelet/lymphocyte, and platelet/neutrophil ratios of neonates of women with hypertensive disease of pregnancy with neonatal birth outcomes

Background: Studies have indicated neutrophil/lymphocyte ratio (NLR), Platelet/Lymphocyte ratio (PLR), and platelet/neutrophils ratio (PNR) to be inflammatory markers. The correlation of these values in infants of hypertensive mothers has not been investigated. Aim: To investigate the relationship between NLR, PLR, and PNR of neonates of women with hypertensive disease of pregnancy and neonatal APGAR scores and birth weight. Methodology: Cord blood samples of 200 neonates collected and the blood counts and ratios obtained. Results: NLR in the babies of the hypertensive mothers was 0.865 and 1.42 in the control group (p = 0.0001). PLR was 34.7 in the neonates of the hypertensive mothers and 62.4 in the control group (p = 0.0001). PNR did not differ significantly between the two groups,p = 0.418. Degree of hypertension had a direct relationship with NLR; SBP had a p value of 0.001 while the DBP had p = 0.002. The PLR had an inverse relationship with the degree of hypertension; SBP p value of 0.0001, while DBP was p = 0.0001. No significant association was observed between the ratios and neonatal birth weight (p ≥ 0.05); however, PNR and PLR were found to be significantly associated with the 1st (p = 0.045 and 0.030) and 5th (0.049 and 0.037) minute APGAR scores in the newborns. Conclusion: PLR and NLR in neonates of hypertensive mothers are found to be markedly lower than those of controls, the degree of which is affected by the severity of hypertension. Also, lower PLR is associated with lower APGAR scores. Therefore, severity of high blood pressure and lower PLR may be determinants of poor birth outcome