Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi
Abstract Background Lymphoma is highly associated with HIV in sub-Saharan Africa (SSA), which contributes to worse outcomes relative to resource-rich settings, and frequent failure of first-line chemotherapy. However, there are no second-line treatment descriptions for adults with relapsed or refrac...
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| Format: | Article |
| Language: | English |
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BMC
2017-08-01
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| Series: | Infectious Agents and Cancer |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13027-017-0156-3 |
| _version_ | 1817977491518652416 |
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| author | Bongani Kaimila Toon van der Gronde Christopher Stanley Edwards Kasonkanji Maria Chikasema Blessings Tewete Paula Fox Satish Gopal |
| author_facet | Bongani Kaimila Toon van der Gronde Christopher Stanley Edwards Kasonkanji Maria Chikasema Blessings Tewete Paula Fox Satish Gopal |
| author_sort | Bongani Kaimila |
| collection | DOAJ |
| description | Abstract Background Lymphoma is highly associated with HIV in sub-Saharan Africa (SSA), which contributes to worse outcomes relative to resource-rich settings, and frequent failure of first-line chemotherapy. However, there are no second-line treatment descriptions for adults with relapsed or refractory lymphoma (RRL) in SSA. Methods We describe HIV+ and HIV- patients with RRL receiving salvage chemotherapy in Malawi. Patients were prospectively treated at a national teaching hospital in Lilongwe, with the modified EPIC regimen (etoposide, prednisolone, ifosfamide, cisplatin) between June 2013 and May 2016, after failing prior first-line chemotherapy. Results Among 21 patients (18 relapsed, 3 refractory), median age was 40 years (range 16–78), 12 (57%) were male. Thirteen patients (62%) were HIV+, of whom 12 (92%) were on antiretroviral therapy (ART) at initiation of salvage chemotherapy, with median CD4 cell count 139 cells/μL (range 12–529) and 11 (85%) with suppressed HIV RNA. Median number of EPIC cycles was 3 (range 1–6), and the commonest toxicity was grade 3/4 neutropenia in 19 patients (90%). Fifteen patients responded (3 complete, 12 partial, overall response rate 71%), but durations were brief. Median overall survival was 4.5 months [95% confidence interval (CI) 2.4–5.6]. However, three patients, all HIV+, experienced sustained remissions. Tolerability, response, and survival did not differ by HIV status. Conclusions The appropriateness and cost-effectiveness of this approach in severely resource-limited environments is uncertain, and multifaceted efforts to improve first-line lymphoma treatment should be emphasized, to reduce frequency with which patients require salvage chemotherapy. Trial registration NCT02835911 . Registered 19 January 2016. |
| first_indexed | 2024-04-13T22:17:09Z |
| format | Article |
| id | doaj.art-20cbeea38f9b42b8b7ae37d687c3b166 |
| institution | Directory Open Access Journal |
| issn | 1750-9378 |
| language | English |
| last_indexed | 2024-04-13T22:17:09Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Infectious Agents and Cancer |
| spelling | doaj.art-20cbeea38f9b42b8b7ae37d687c3b1662022-12-22T02:27:25ZengBMCInfectious Agents and Cancer1750-93782017-08-011211610.1186/s13027-017-0156-3Salvage chemotherapy for adults with relapsed or refractory lymphoma in MalawiBongani Kaimila0Toon van der Gronde1Christopher Stanley2Edwards Kasonkanji3Maria Chikasema4Blessings Tewete5Paula Fox6Satish Gopal7UNC Project-MalawiUNC Project-MalawiUNC Project-MalawiUNC Project-MalawiUNC Project-MalawiUNC Project-MalawiUNC Project-MalawiUNC Project-MalawiAbstract Background Lymphoma is highly associated with HIV in sub-Saharan Africa (SSA), which contributes to worse outcomes relative to resource-rich settings, and frequent failure of first-line chemotherapy. However, there are no second-line treatment descriptions for adults with relapsed or refractory lymphoma (RRL) in SSA. Methods We describe HIV+ and HIV- patients with RRL receiving salvage chemotherapy in Malawi. Patients were prospectively treated at a national teaching hospital in Lilongwe, with the modified EPIC regimen (etoposide, prednisolone, ifosfamide, cisplatin) between June 2013 and May 2016, after failing prior first-line chemotherapy. Results Among 21 patients (18 relapsed, 3 refractory), median age was 40 years (range 16–78), 12 (57%) were male. Thirteen patients (62%) were HIV+, of whom 12 (92%) were on antiretroviral therapy (ART) at initiation of salvage chemotherapy, with median CD4 cell count 139 cells/μL (range 12–529) and 11 (85%) with suppressed HIV RNA. Median number of EPIC cycles was 3 (range 1–6), and the commonest toxicity was grade 3/4 neutropenia in 19 patients (90%). Fifteen patients responded (3 complete, 12 partial, overall response rate 71%), but durations were brief. Median overall survival was 4.5 months [95% confidence interval (CI) 2.4–5.6]. However, three patients, all HIV+, experienced sustained remissions. Tolerability, response, and survival did not differ by HIV status. Conclusions The appropriateness and cost-effectiveness of this approach in severely resource-limited environments is uncertain, and multifaceted efforts to improve first-line lymphoma treatment should be emphasized, to reduce frequency with which patients require salvage chemotherapy. Trial registration NCT02835911 . Registered 19 January 2016.http://link.springer.com/article/10.1186/s13027-017-0156-3Non-Hodgkin lymphomaHodgkin lymphomaSub-Saharan AfricaChemotherapyHIV |
| spellingShingle | Bongani Kaimila Toon van der Gronde Christopher Stanley Edwards Kasonkanji Maria Chikasema Blessings Tewete Paula Fox Satish Gopal Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi Infectious Agents and Cancer Non-Hodgkin lymphoma Hodgkin lymphoma Sub-Saharan Africa Chemotherapy HIV |
| title | Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi |
| title_full | Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi |
| title_fullStr | Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi |
| title_full_unstemmed | Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi |
| title_short | Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi |
| title_sort | salvage chemotherapy for adults with relapsed or refractory lymphoma in malawi |
| topic | Non-Hodgkin lymphoma Hodgkin lymphoma Sub-Saharan Africa Chemotherapy HIV |
| url | http://link.springer.com/article/10.1186/s13027-017-0156-3 |
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