Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort study.

Autor:	Mponda M; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Kudowa E; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Craven DM; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Eastburg LC; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi.; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Chikasema M; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Kasonkanji E; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Tomoka T; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Roush SM; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Simwinga L; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Mumba N; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi., Gopal S; Center for Global Health, National Cancer Institute, Rockville, MD, USA., Fedoriw Y; University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi.; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Painschab MS; University 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.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2024 Feb 08; Vol. 69, pp. 102480. Date of Electronic Publication: 2024 Feb 08 (Print Publication: 2024).
DOI:	10.1016/j.eclinm.2024.102480
Abstrakt:	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. Competing Interests: We declare no competing interests. This work was completed while Dr. Satish Gopal was employed at the University of North Carolina at Chapel Hill. The opinions expressed in this article are the authors own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States Government. (© 2024 The Author(s).)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu