Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi
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Kaimila, Bongani, et al. Salvage Chemotherapy for Adults with Relapsed Or Refractory Lymphoma In Malawi. BioMed Central, 2017. https://doi.org/10.17615/9ews-w785APA
Kaimila, B., Van Der Gronde, T., Stanley, C., Kasonkanji, E., Chikasema, M., Tewete, B., Fox, P., & Gopal, S. (2017). Salvage chemotherapy for adults with relapsed or refractory lymphoma in Malawi. BioMed Central. https://doi.org/10.17615/9ews-w785Chicago
Kaimila, Bongani, Toon Van Der Gronde, Christopher Stanley, Edwards Kasonkanji, Maria Chikasema, Blessings Tewete, Paula Fox et al. 2017. Salvage Chemotherapy for Adults with Relapsed Or Refractory Lymphoma In Malawi. BioMed Central. https://doi.org/10.17615/9ews-w785- Creator
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Kaimila, Bongani
- Affiliation: School of Medicine, UNC Project-Malawi
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van der Gronde, Toon
- Affiliation: School of Medicine, UNC Project-Malawi
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Stanley, Christopher
- Affiliation: School of Medicine, UNC Project-Malawi
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Kasonkanji, Edwards
- Affiliation: School of Medicine, UNC Project-Malawi
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Chikasema, Maria
- Affiliation: School of Medicine, UNC Project-Malawi
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Tewete, Blessings
- Affiliation: School of Medicine, UNC Project-Malawi
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Fox, Paula
- Affiliation: School of Medicine, UNC Project-Malawi
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Gopal, Satish
- Affiliation: School of Medicine, UNC Project-Malawi
- Abstract
- 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.
- Date of publication
- August 9, 2017
- DOI
- Identifier
- Resource type
- Article
- Rights statement
- In Copyright
- Rights holder
- The Author(s).
- Journal title
- Infectious Agents and Cancer
- Journal volume
- 12
- Journal issue
- 1
- Language
- English
- Bibliographic citation
- Infectious Agents and Cancer. 2017 Aug 09;12(1):45
- Publisher
- BioMed Central
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