Better outcomes for patients with non-Hodgkin lymphoma (NHL) in sub-Saharan Africa (SSA) will necessitate changes in diagnostics, surveillance, and treatment practices, according to an editorial recently published in the British Journal of Haematology.1

The editorial was authored by Matthew S. Painschab, MD, of the University of North Carolina in Chapel Hill, and colleagues. In it they described limitations in cancer care across sub-Saharan Africa and addressed a companion study on features of NHL in SSA that was also published in the same issue of the journal.1

“First and most critically, limitations in pathologic infrastructure and reach of cancer registries in SSA make conclusions on the NHL disease burden difficult to quantify with certainty,” Dr Painschab and colleagues wrote in their report.1

In the companion study, Nikolaus CS Mezger, of Martin-Luther-University Halle-Wittenberg in Germany, and colleagues assessed clinical characteristics of NHL in 516 patients from 10 countries of SSA. Subtyping was possible in only 42% of patients because of limited cytological and histological information.Among evaluable patients, diffuse large B-cell lymphoma (DLBCL) was the most common form of NHL, occurring in 48.8% of patients, while chronic lymphocytic leukemia (18.4%) and Burkitt lymphoma (6.0%) were also common. Among 178 patients with available staging data, 73.0% had advanced disease.2

Dr Painschab and colleagues emphasized the importance of accurate subtyping, considering that outcomes with therapies can differ widely between lymphoma subtypes; for example, treatment with cyclophosphamide, vincristine, doxorubicin, and prednisone is relatively successful for DLBCL, while being less effective against certain other lymphomas.1

Information regarding clinical criteria used for prognostic assessments and treatment decisions is also limited in the SSA, according to Dr Painschab and colleagues. However, they also noted that a shortage of trained pathologists in the region may be aided by telepathology and other uses of technology for training and diagnostics.1

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Organizations can potentially play a role in enabling improvements in cancer care throughout the SSA. “Investments in pathology capacity that are underway in the region will provide the groundwork for future region-specific and context-specific clinical trials to improve survival for non-Hodgkin lymphoma,” Dr Painschab and colleagues concluded in their report.1

References

  1. Painschab MS, Westmoreland KD, Tomoka T. Improving outcomes for non-Hodgkin lymphoma in sub-Saharan Africa: where to start? [published online March 24, 2020]. Br J Haematol. doi: 10.1111/bjh.16617
  2. Mezger NCS, Feuchtner J, Griesel M, et al. Clinical presentation and diagnosis of adult patients with non-Hodgkin lymphoma in sub-Saharan Africa [published online March 17, 2020]. Br J Haematol. doi: 10.1111/bjh.16575