Burkitt Lymphoma: A Potentially Curable Childhood Tumour: Experience in Ile-Ife, Nigeria (1986-2014)

Background: Burkitt lymphoma (BL) is the commonest tumour among Nigerian children. It is reported to be highly responsive to readily available cytotoxic drugs; yet, the outcome of therapy remains abysmal.Objectives: To review the epidemiology of BL in terms of risk factors, age incidence, regional distribution, disease sub-types, examine the available treatment regimens locally and internationally and report on the outcome of treatment in Nigeria under different conditions.Methods: A comprehensive literature review on the epidemiology of BL was undertaken and results of publications and clinical trials of BL were evaluated.Results: Three major sub-types of Burkitt lymphoma are recognised in the world literature; the classic endemic BL (eBL) in sub-Saharan Africa, EBV-independent sporadic BL (sBL) found in population outside the endemic areas and the HIV-related BL (HIV-BL), which is found in regions with high incidence of HIV infection. All the sub-types have common cytogenetic abnormalities: t (8, 14), t (8, 22), and t (2, 8). The COM regimen incorporating cyclophosphamide, oncovin and methotrexate (with the intrathecal cytarabine and methotrexate), was found to be very effective for eBL. Treatment outcome was dismal for the self-financed patients treated with COM regimen between 1986 and 2000 (Group A) compared to the internationally sponsored patients treated between 2000 and 2014 (Group B). While 16.8% of Group A patients had no chemotherapy, 9.8% were lost to toxic deaths and 88% defaulted; most of the patients in group B had full chemotherapy; the Event-Free Survival (EFS) rates at 12 and 24 months were 58.3% and 53.4%, respectively

Chronic Lymphocytic Leukaemia: A-Twenty-Years Experience and Problems in Ile-Ife; South-Western Nigeria

Aim: To investigate the usefulness of some clinical and laboratory parameters in assessing the prognosis and survival of CLL in a resource-limited setting. Methods : Between September 1986 and March 2007; 79 consecutive patients were retrospectively studied. Diagnosis was based on clinical and haematological findings. Results : A total of 79 patients; aged 30 to 81 (median = 60) years were managed. There were 34 males and 45 females (ratio = 0.8:1). About 86.1were aged above 50 years. Massive splenomegaly and hepatomegaly were recorded in 70.9and 29.1of patients; respectively. More than 63presented in stage C. Anaemia was recorded in 74.7. Haematocrit correlated negatively with WBC but positively with platelet count. The spleen correlated positively with liver. The overall survival at 2 years was 70.2. Logistic regression showed that younger age; male sex; higher haematocrit; and lower platelet count improved survival; while lower WBC; moderate hepatomegaly and splenomegaly conferred survival advantage. Conclusion : It could be concluded that massive splenomegaly is a common finding in the majority of our patients. Non availability of immunophenotyping facility is a major constraint

AIDS-related lymphomas in Nigeria

Aggressive non-Hodgkin's lymphoma (NHL), including primary central nervous system (CNS) lymphoma, lymphoblastic lymphoma and non-endemic Burkitt's lymphoma have been recognized as AIDS-defining cancers in most developed countries. However, HIV/AIDS epidemics appear not to have been associated with higher incidence of lymphomas in Africa. We therefore carried out this study to highlight the significance or otherwise of HIV/AIDS epidemics in the pathogenesis of lymphomas in a population of Nigerians with the disease. Since January 1993 to the present, all patients with haematologic cancers are routinely screened (following appropriate counseling) for HIV infection. Patients with a histological diagnosis of malignant chronic lymphoproliferative diseases {non-Hodgkin lymphoma (NHL), chronic lymphocytic leukaemia (CLL), Burkitt's lymphoma (BL) and Hodgkin lymphoma (HL)} at the Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife from January 1993 to August 2008 were noted. Those patients confirmed to be HIV/AIDS positive among the cohort with lymphomas were retrospectively studied using their clinical case notes. Data obtained were analyzed using appropriate descriptive and inferential statistics. A total of 391 patients were histologically confirmed to have lymphoma {NHL-109, (27.9 percent); CLL-76, (19.4 percent); BL-178, (45.5 percent) and HL-28, (7.2 percent)} during the study period. Nine patients (2.3 percent) were confirmed to be HIV- positive, all within the age bracket 24-60 (median = 50) years. Six of these, five males and one female, ages 24-60 (median = 37.5) years, had NHL while another three, all females (age 50 - 68years; median = 56 years) had CLL. None of the patients with HL and BL were HIV positive. Patients with NHL presented at advanced stage of the disease (at least clinical stage IIIb), and all those with CLL presented at stage C of the International Working Party Classification. All the HIV-positive patients ...

Multiple myeloma : 2 case reports

This is a report of multiple myeloma in first cousins from the Niger delta region of Nigeria.The first patient was a 60-year-old Negroid male with a 3-month history of productive cough; chest pain; fever and 1 month history of weight loss. The diagnosis was confirmed by greater than 50neoplastic plasma cells in the bone marrow; monoclonal band on electrophoresis and lytic bone lesions in the skull. He was treated with cyclophosphamide; prednisolone and allopurinol and received a total of 4 pints of packed cells. His PCV improved subsequently.The second patient was a 54-year-old Negroid housewife. She presented with a six-month history of bone pains and weakness in both lower limbs. She also had cough productive of mucoid sputum. The diagnosis of MM was confirmed by the presence of more than 30neoplastic plasma cells in the bone marrow; a monoclonal band on serum electrophoresis and lytic lesions in the pelvic bones on skeletal survey. She had three 28-day cycles of vincristine; adriamycin and dexamethasone (VAD). She was also transfused with 3 pints of packed cells. We conclude that while we cannot rule out the effect of environmental factors in pathogenesis of MM in our patients; the occurrence of MM in first cousins is suggestive of a possible familial origin. We advocate screening of urine for Bence Jones protein and serum electrophoresis for relatives of patients with MM; especially those from the Niger Delta region