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

Katherine D. Westmoreland, Christopher C. Stanley, Nathan D. Montgomery, Bongani Kaimila, Edwards Kasonkanji, Nader Kim El-Mallawany, Peter Wasswa, Idah Mtete, Mercy Butia, Salama Itimu, Mary Chasela, Mary Mtunda, Maria Chikasema, Victor Makwakwa, Coxcilly Kampani, Bal M. Dhungel, Marcia K. Sanders, Robert Krysiak, Tamiwe Tomoka, N. George Liomba & 3 others Dirk P. Dittmer, Yuri Fedoriw, Satish Gopal

Research output: Contribution to journalArticle

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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) log10copies/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.

LanguageEnglish (US)
Article numbere26302
JournalPediatric Blood and Cancer
Volume64
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Malawi
Human Herpesvirus 4
Hodgkin Disease
Lymphoma
HIV
X-Linked Combined Immunodeficiency Diseases
Confidence Intervals
Therapeutics
Africa South of the Sahara
Viremia
Delayed Diagnosis
DNA
CD4 Lymphocyte Count
Viral Load
Disease-Free Survival
Anemia
Neoplasms
Hemoglobins
Survival

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Westmoreland, K. D., Stanley, C. C., Montgomery, N. D., Kaimila, B., Kasonkanji, E., El-Mallawany, N. K., ... Gopal, S. (2017). Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study. Pediatric Blood and Cancer, 64(5), [e26302]. DOI: 10.1002/pbc.26302

Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi : Longitudinal results from the Kamuzu Central Hospital Lymphoma study. / Westmoreland, Katherine D.; Stanley, Christopher C.; Montgomery, Nathan D.; Kaimila, Bongani; Kasonkanji, Edwards; El-Mallawany, Nader Kim; Wasswa, Peter; Mtete, Idah; Butia, Mercy; Itimu, Salama; Chasela, Mary; Mtunda, Mary; Chikasema, Maria; Makwakwa, Victor; Kampani, Coxcilly; Dhungel, Bal M.; Sanders, Marcia K.; Krysiak, Robert; Tomoka, Tamiwe; Liomba, N. George; Dittmer, Dirk P.; Fedoriw, Yuri; Gopal, Satish.

In: Pediatric Blood and Cancer, Vol. 64, No. 5, e26302, 01.05.2017.

Research output: Contribution to journalArticle

Westmoreland, KD, Stanley, CC, Montgomery, ND, Kaimila, B, Kasonkanji, E, El-Mallawany, NK, Wasswa, P, Mtete, I, Butia, M, Itimu, S, Chasela, M, Mtunda, M, Chikasema, M, Makwakwa, V, Kampani, C, Dhungel, BM, Sanders, MK, Krysiak, R, Tomoka, T, Liomba, NG, Dittmer, DP, Fedoriw, Y & Gopal, S 2017, 'Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study' Pediatric Blood and Cancer, vol. 64, no. 5, e26302. DOI: 10.1002/pbc.26302
Westmoreland KD, Stanley CC, Montgomery ND, Kaimila B, Kasonkanji E, El-Mallawany NK et al. Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study. Pediatric Blood and Cancer. 2017 May 1;64(5). e26302. Available from, DOI: 10.1002/pbc.26302
Westmoreland, Katherine D. ; Stanley, Christopher C. ; Montgomery, Nathan D. ; Kaimila, Bongani ; Kasonkanji, Edwards ; El-Mallawany, Nader Kim ; Wasswa, Peter ; Mtete, Idah ; Butia, Mercy ; Itimu, Salama ; Chasela, Mary ; Mtunda, Mary ; Chikasema, Maria ; Makwakwa, Victor ; Kampani, Coxcilly ; Dhungel, Bal M. ; Sanders, Marcia K. ; Krysiak, Robert ; Tomoka, Tamiwe ; Liomba, N. George ; Dittmer, Dirk P. ; Fedoriw, Yuri ; Gopal, Satish. / Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi : Longitudinal results from the Kamuzu Central Hospital Lymphoma study. In: Pediatric Blood and Cancer. 2017 ; Vol. 64, No. 5.
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title = "Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study",
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) log10copies/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.",
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T1 - Hodgkin lymphoma, HIV, and Epstein–Barr virus in Malawi

T2 - Pediatric Blood and Cancer

AU - Westmoreland,Katherine D.

AU - Stanley,Christopher C.

AU - Montgomery,Nathan D.

AU - Kaimila,Bongani

AU - Kasonkanji,Edwards

AU - El-Mallawany,Nader Kim

AU - Wasswa,Peter

AU - Mtete,Idah

AU - Butia,Mercy

AU - Itimu,Salama

AU - Chasela,Mary

AU - Mtunda,Mary

AU - Chikasema,Maria

AU - Makwakwa,Victor

AU - Kampani,Coxcilly

AU - Dhungel,Bal M.

AU - Sanders,Marcia K.

AU - Krysiak,Robert

AU - Tomoka,Tamiwe

AU - Liomba,N. George

AU - Dittmer,Dirk P.

AU - Fedoriw,Yuri

AU - Gopal,Satish

PY - 2017/5/1

Y1 - 2017/5/1

N2 - 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) log10copies/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.

AB - 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) log10copies/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.

KW - Epstein–Barr virus

KW - Hodgkin lymphoma

KW - Malawi

KW - pediatric cancer

KW - sub-Saharan Africa

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U2 - 10.1002/pbc.26302

DO - 10.1002/pbc.26302

M3 - Article

VL - 64

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