Adult Lymphomas in a Tertiary Hospital in South – South Nigeria: A Review of Clinicopathologic Features and Treatment Outcome

Background: There has been an increase in the prevalence of Lymphomas in our environment lately. Thorough literature search reveals a limited number of reports on the prevalence of Lymphoma and no information on the clinicopathologic pattern and outcome of treatment of this disease in our centre. Data on the burden of Lymphoma across different regions are important, as there may be variation in incidence in different locations even within the same country. This will keep healthcare providers informed about the current trend of Lymphomas in the region and facilitate prompt and appropriate diagnosis and treatment as well as assist Government agencies in better healthcare planning.

Aim: To determine the burden, clinicopathologic characteristics and treatment outcome of Lymphoma among a cohort of adult patients accessing care in a Referral Hospital in Southern Nigeria

Methods: This was a longitudinal prospective study of all lymphoma cases managed in the Department of Haematology, University of Uyo Teaching Hospital, Uyo, between January 1, 2014 and December 31, 2018

Results: There were 59 cases. Forty 40 (67.8%) were males and 19(32.2%)were females giving a male to female ratio of 4.4:1. Hodgkin Lymphoma(HL) accounted for 11(18.6%) of the cases while Non-Hodgkin Lymphoma(NHL) accounted for 48( 81.4%)of the cases , with the mean ages for HL and NHL patients being 32.09 +9.22 years and 40.88 + 12.21 years, respectively. The distribution of the different histologic subtypes of the malignancy were as follows: HL; Nodular Lymphocyte Predominant(7cases;63.6%), Nodular Sclerosis(2 cases;18.2%) and Lymphocyte Depleted(2 cases;18.2%). NHL; Small Lymphocytic Lymphoma(23cases;47.9%),Diffuse Large Cell Lymphoma(15 cases;31.3%),unspecified

(4 cases;8.3%), Follicular Lymphoma(2 cases;4.2%),Lymphoblastic Lymphoma(2 cases;4.2%), Mantle Cell Lymphoma(1 case;2.1%) and Adult T-Cell Lymphoma(1 case;2.1%). Fourteen 14 (29.2%) out of all the NHL patients had immunohistochemistry and only nine 9 of them were CD20 positive. Relapse rate among the cohort was 11.9% (7/59), while 15.3% (9/59) were still in remission. The cure rate was 5.1%, loss to follow up was 22.0% and 37.3% of patients died in the course of therapy either from advanced disease, non -compliance to treatment or late presentation. All the HL patients received ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) regimen alone. Majority of the NHL patients (91.7%, 44/48) received CHOP (Cyclophosphamide, Doxorubicin, Oncovin and Prednisolone) regimen alone, while 8.3% (4/48) received Rituximab with CHOP (R-CHOP).

Conclusion: The clinicopathological profile, age and sex distribution of lymphoma in our study were comparable to those reported by other authors with nodular lymphocyte predominant being the most common HL histologic subtype and small lymphocytic lymphoma the predominant NHL histologic subtype in our environment. The general outcome was very poor with a high default rate and unsettling mortality figures.