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

in EClinicalMedicine by 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

TLDR

  • The study looked at how well a treatment called ABVD works for a type of cancer called Hodgkin lymphoma in people from Malawi. The study found that the treatment was safe, effective, and affordable, but that outcomes were worse than in high-income countries due to HL progression. The study also suggests that there is a need for more research to understand why this is happening and to find better treatments for people with relapsed or refractory HL in Malawi.

Abstract

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. We report a prospective observational cohort of HL (aged15) 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. 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. 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. National Institutes of Health, Lineberger Comprehensive Cancer Center.

Overview

  • The study aimed to fill the knowledge gap on Hodgkin lymphoma (HL) treatment in sub-Saharan Africa, specifically in Malawi, using data from a single tertiary referral center. The study enrolled patients with pathologically confirmed HL between June 1, 2013, and Dec 31, 2021, and followed them up for 5 years. Patients were treated with ABVD and concurrent antiretroviral therapy if HIV-positive. The primary outcome was overall survival, with secondary outcomes including progression-free survival, response assessment, and adverse events. Microcosting of HL diagnosis, treatment, and follow-up was embedded in the study.

Comparative Analysis & Findings

  • The study compared outcomes observed under different experimental conditions, specifically the use of ABVD for HL treatment in Malawi. The results showed that 2-year overall survival was 82% (95% CI 70-96%) and 2-year progression-free survival was 64% (95% CI 50-83%). The study also found that outcomes were worse than in high-income countries due to HL progression. However, the study suggests that treatment with ABVD is safe, efficacious, and affordable for HL in Malawi.

Implications and Future Directions

  • The study's findings have significant implications for the field of research and clinical practice, as they provide evidence that ABVD is an effective and affordable treatment option for HL in sub-Saharan Africa. The study also highlights the need for future research to understand outcome inequities and to assess the efficacy of therapies for patients with relapsed or refractory HL in Malawi. Possible future research directions include studying the long-term outcomes of ABVD treatment and exploring the use of other therapies in combination with ABVD.
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