CHOP Chemotherapy for Aggressive Non-Hodgkin Lymphoma with and without HIV in the Antiretroviral Therapy Era in Malawi

There are no prospective studies of aggressive non-Hodgkin lymphoma (NHL) treated with CHOP in sub-Saharan Africa. We enrolled adults with aggressive NHL in Malawi between June 2013 and May 2015. Chemotherapy and supportive care were standardized, and HIV+ patients received antiretroviral therapy (ART). Thirty-seven of 58 patients (64%) were HIV+. Median age was 47 years (IQR 39–56), and 35 (60%) were male. Thirty-five patients (60%) had stage III/IV, 43 (74%) B symptoms, and 28 (48%) performance status ≥2. B-cell NHL predominated among HIV+ patients, and all T-cell NHL occurred among HIV- individuals. Thirty-one HIV+ patients (84%) were on ART for a median 9.9 months (IQR 1.1–31.7) before NHL diagnosis, median CD4 was 121 cells/μL (IQR 61–244), and 43% had suppressed HIV RNA. HIV+ patients received a similar number of CHOP cycles compared to HIV- patients, but more frequently developed grade 3/4 neutropenia (84% vs 31%, p = 0.001), resulting in modestly lower cyclophosphamide and doxorubicin doses with longer intervals between cycles. Twelve-month overall survival (OS) was 45% (95% CI 31–57%). T-cell NHL (HR 3.90, p = 0.017), hemoglobin (HR 0.82 per g/dL, p = 0.017), albumin (HR 0.57 per g/dL, p = 0.019), and IPI (HR 2.02 per unit, p<0.001) were associated with mortality. HIV was not associated with mortality, and findings were similar among patients with diffuse large B-cell lymphoma. Twenty-three deaths were from NHL (12 HIV+, 11 HIV-), and 12 from CHOP (9 HIV+, 3 HIV-). CHOP can be safe, effective, and feasible for aggressive NHL in Malawi with and without HIV

Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi

Burkitt lymphoma (BL) is the most common paediatric cancer in sub-Saharan Africa (SSA). Anthracyline-based treatment is standard in resource-rich settings, but has not been described in SSA. Children ≤ 18 years of age with newly diagnosed BL were prospectively enrolled from June 2013 to May 2015 in Malawi. Staging and supportive care were standardized, as was treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for six cycles. Among 73 children with BL, median age was 9.2 years (interquartile range 7.7–11.8), 48 (66%) were male and two were positive for human immunodeficiency virus. Twelve (16%) had stage I/II disease, 36 (49%) stage III and 25 (34%) stage IV. Grade 3/4 neutropenia occurred in 17 (25%), and grade 3/4 anaemia in 29 (42%) of 69 evaluable children. Eighteen-month overall survival was 29% (95% confidence interval [CI] 18–41%) overall. Mortality was associated with age >9 years [hazard ratio [HR] 2.13, 95% CI 1.15–3.94], female gender (HR 2.12, 95% CI 1.12–4.03), stage (HR 1.52 per unit, 95% CI 1.07–2.17), lactate dehydrogenase (HR 1.03 per 100 iu/l, 95% CI 1.01–1.05), albumin (HR 0. 96 per g/l, 95% CI 0.93–0.99) and performance status (HR 0.78 per 10-point increase, 95% CI 0.69–0.89). CHOP did not improve outcomes in paediatric BL compared to less intensive regimens in Malawi

Treatment course and toxicities during CHOP chemotherapy in Lilongwe, Malawi.

<p>Treatment course and toxicities during CHOP chemotherapy in Lilongwe, Malawi.</p

Peripheral blood counts with interquartile ranges during CHOP chemotherapy in Lilongwe, Malawi.

<p>Peripheral blood counts with interquartile ranges during CHOP chemotherapy in Lilongwe, Malawi.</p

Risk factors for mortality among aggressive non-Hodgkin lymphoma patients in Lilongwe, Malawi.

<p>Risk factors for mortality among aggressive non-Hodgkin lymphoma patients in Lilongwe, Malawi.</p

Overall survival estimates for aggressive non-Hodgkin lymphoma in Lilongwe, Malawi.

<p>Overall survival estimates for aggressive non-Hodgkin lymphoma in Lilongwe, Malawi.</p

Neutropenia during CHOP chemotherapy in Lilongwe, Malawi.

<p>Neutropenia during CHOP chemotherapy in Lilongwe, Malawi.</p

Baseline characteristics for adults with aggressive non-Hodgkin lymphoma in Lilongwe, Malawi, June 2013 to May 2015.

<p>Baseline characteristics for adults with aggressive non-Hodgkin lymphoma in Lilongwe, Malawi, June 2013 to May 2015.</p

Overall survival for aggressive non-Hodgkin lymphoma in Lilongwe, Malawi.

<p>(A) Overall cohort with 95% confidence intervals. (B) Aggressive B-cell non-Hodgkin lymphoma (ABNHL) versus aggressive T-cell non-Hodgkin lymphoma (ATNHL). (C) Stratified by HIV status. (D) Stratified by international prognostic index (IPI). (E) Diffuse large B-cell lymphoma (DLBCL) stratified by HIV status. (F) DBLCL stratified by IPI.</p