Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in context
Summary: Background: ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) is a proven, curative regimen for Hodgkin lymphoma (HL). Prospective data describing HL treatment in sub-Saharan Africa are limited. We aimed to fill this knowledge gap, using data from Malawi. Methods: We report a p...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024000592 |
| _version_ | 1827355236653596672 |
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| author | Marriam Mponda Evaristar Kudowa Dalton M. Craven Luke C. Eastburg Maria Chikasema Edwards Kasonkanji Tamiwe Tomoka Sophie Maharry Roush Lusayo Simwinga Noel Mumba Satish Gopal Yuri Fedoriw Matthew S. Painschab |
| author_facet | Marriam Mponda Evaristar Kudowa Dalton M. Craven Luke C. Eastburg Maria Chikasema Edwards Kasonkanji Tamiwe Tomoka Sophie Maharry Roush Lusayo Simwinga Noel Mumba Satish Gopal Yuri Fedoriw Matthew S. Painschab |
| author_sort | Marriam Mponda |
| collection | DOAJ |
| description | Summary: Background: ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) is a proven, curative regimen for Hodgkin lymphoma (HL). Prospective data describing HL treatment in sub-Saharan Africa are limited. We aimed to fill this knowledge gap, using data from Malawi. Methods: We report a prospective observational cohort of HL (aged ≥ 15) from a single, tertiary referral centre in Malawi. We enrolled patients with pathologicially confirmed Hodgkin lymphoma between June 1, 2013, and Dec 31, 2021 with follow-up censored on May 31, 2022. Patients were treated with ABVD and concurrent antiretroviral therapy if HIV-positive and were followed up for 5 years. The primary outcome was overall survival; secondary outcomes included progression-free survival, response assessment, and adverse events. Microcosting of HL diagnosis, treatment, and follow-up was embedded. Findings: We enrolled 38 patients with a median age of 27 years (interquartile range 19–46); eleven (28%) were HIV-positive. Of 35 patients treated with ABVD, 24 (71%) had stage III/IV, nine (26%) unfavourable limited stage, and two (6%) favourable limited stage. Among HIV-infected individuals, mean CD4 count at HL diagnosis was 179 cells/uL and ten (91%) had HIV RNA < 400 copies/mL. Grade 3/4 neutropenia occurred in 24 (68%) patients and caused treatment delay in 16 (46%). Of ten deaths, seven were due to HL, two possible treatment-related toxicity, and one uncertain. 2-year overall survival was 82% (95% CI 70–96%) and 2-year progression-free survival was 64% (95% CI 50–83%). PFS appeared better for HIV-positive patients (HR 0.23 (95% CI 0.05–1.02)) after controlling for stage and performance status (p = 0.05). We estimated $2708 (2022 USD) for HL diagnosis, treatment, and follow-up in our cohort. Interpretation: Our findings suggest that treatment with ABVD is safe, efficacious, and affordable for HL in Malawi. Outcomes are worse than in high-income countries due to HL progression. Future studies are needed to understand outcome inequities and to assess efficacy of therapies for patients with relapsed or refractory HL in Malawi. Funding: National Institutes of Health, Lineberger Comprehensive Cancer Center. |
| first_indexed | 2024-03-08T04:06:44Z |
| format | Article |
| id | doaj.art-94b788870e5a4755801c75ba9d06bdef |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-03-08T04:06:44Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-94b788870e5a4755801c75ba9d06bdef2024-02-09T04:49:00ZengElsevierEClinicalMedicine2589-53702024-03-0169102480Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in contextMarriam Mponda0Evaristar Kudowa1Dalton M. Craven2Luke C. Eastburg3Maria Chikasema4Edwards Kasonkanji5Tamiwe Tomoka6Sophie Maharry Roush7Lusayo Simwinga8Noel Mumba9Satish Gopal10Yuri Fedoriw11Matthew S. Painschab12University of North Carolina (UNC) Project Malawi, Lilongwe, MalawiUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiUniversity of North Carolina (UNC) Project Malawi, Lilongwe, Malawi; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiDepartment of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiUniversity of North Carolina (UNC) Project Malawi, Lilongwe, MalawiCenter for Global Health, National Cancer Institute, Rockville, MD, USAUniversity of North Carolina (UNC) Project Malawi, Lilongwe, Malawi; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAUniversity of North Carolina (UNC) Project Malawi, Lilongwe, Malawi; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Corresponding author. UNC Project Lilongwe, Tidziwe Centre, Private Bag A/104, Lilongwe, Malawi.Summary: Background: ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) is a proven, curative regimen for Hodgkin lymphoma (HL). Prospective data describing HL treatment in sub-Saharan Africa are limited. We aimed to fill this knowledge gap, using data from Malawi. Methods: We report a prospective observational cohort of HL (aged ≥ 15) from a single, tertiary referral centre in Malawi. We enrolled patients with pathologicially confirmed Hodgkin lymphoma between June 1, 2013, and Dec 31, 2021 with follow-up censored on May 31, 2022. Patients were treated with ABVD and concurrent antiretroviral therapy if HIV-positive and were followed up for 5 years. The primary outcome was overall survival; secondary outcomes included progression-free survival, response assessment, and adverse events. Microcosting of HL diagnosis, treatment, and follow-up was embedded. Findings: We enrolled 38 patients with a median age of 27 years (interquartile range 19–46); eleven (28%) were HIV-positive. Of 35 patients treated with ABVD, 24 (71%) had stage III/IV, nine (26%) unfavourable limited stage, and two (6%) favourable limited stage. Among HIV-infected individuals, mean CD4 count at HL diagnosis was 179 cells/uL and ten (91%) had HIV RNA < 400 copies/mL. Grade 3/4 neutropenia occurred in 24 (68%) patients and caused treatment delay in 16 (46%). Of ten deaths, seven were due to HL, two possible treatment-related toxicity, and one uncertain. 2-year overall survival was 82% (95% CI 70–96%) and 2-year progression-free survival was 64% (95% CI 50–83%). PFS appeared better for HIV-positive patients (HR 0.23 (95% CI 0.05–1.02)) after controlling for stage and performance status (p = 0.05). We estimated $2708 (2022 USD) for HL diagnosis, treatment, and follow-up in our cohort. Interpretation: Our findings suggest that treatment with ABVD is safe, efficacious, and affordable for HL in Malawi. Outcomes are worse than in high-income countries due to HL progression. Future studies are needed to understand outcome inequities and to assess efficacy of therapies for patients with relapsed or refractory HL in Malawi. Funding: National Institutes of Health, Lineberger Comprehensive Cancer Center.http://www.sciencedirect.com/science/article/pii/S2589537024000592Hodgkin lymphomaHIVABVDSub-Saharan AfricaCostMicrocosting |
| spellingShingle | Marriam Mponda Evaristar Kudowa Dalton M. Craven Luke C. Eastburg Maria Chikasema Edwards Kasonkanji Tamiwe Tomoka Sophie Maharry Roush Lusayo Simwinga Noel Mumba Satish Gopal Yuri Fedoriw Matthew S. Painschab Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in context EClinicalMedicine Hodgkin lymphoma HIV ABVD Sub-Saharan Africa Cost Microcosting |
| title | Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in context |
| title_full | Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in context |
| title_fullStr | Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in context |
| title_full_unstemmed | Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in context |
| title_short | Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort studyResearch in context |
| title_sort | safety efficacy and affordability of abvd for hodgkin lymphoma in malawi a prospective cohort studyresearch in context |
| topic | Hodgkin lymphoma HIV ABVD Sub-Saharan Africa Cost Microcosting |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024000592 |
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