Rezumat
Background: The incidence of Haematologic malignancies has been shown to vary according to gender, age, geographic region, and histologic subtypes, while cure rates can vary according to region and may be impacted by treatment availability and access to care.
Method: This was an institution based review of data from the Medical Records Department, Department of Haematology and Cancer Registry of the Histopathology Department of the University of Maiduguri Teaching Hospital between January 1998 and December 2011. The aim was to study the spectrum of Haematologic malignancies and the survival pattern of adult lymphomas in this region and to compare our findings to studies reported elsewhere.
Results: The Haematologic malignancies represented 6.05% of all cancer cases seen and 0.31% of hospital admissions. Among the Haematologic malignancies, Non-Hodgkins Lymphoma (NHL) was the most frequent, constituting 51.3% while others include: Hodgkins Lymphoma (HL), 26.7 % Chronic Myeloid Leukaemia (CML), 5.5%, Acute Myeloblastic leukaemia (AML), 4.2% Multiple Myeloma (MM), 4.2% Acute Lymphoblastic leukaemia (ALL), 3.8%, Chronic Lymphocytic Leukaemia (CLL), 3.4% Myelodysplastic Syndrome (MDS), 0.4% and Chronic Myelofibrosis 0.4%. Haematologic malignancies are more common in younger age group and also more common in males than females. Lymphomas are particularly common in young adults and the incidence tends to fall after 70 years. Similarly, the characteristic bimodal age incidence for HL found in western world has not been seen in this study. The histological subtypes for both NHL and HL are similar to the pattern reported elsewhere. Default rate was high and we found a strong association between cycles of chemotherapy given and survival in lymphoma patients.
Conclusion: This study has shown that Haematologic malignancies are not uncommon in our environment. There is need toprovide basic facilities and training for immunophenotyping and immunohistochemistry in all cancer treatment centers across the country. Cytotoxic drugs must be subsidized and also be made readily available to all patients with Haematologic malignancies.
Keywords: Haematologic malignancies, survival, lymphomas, Maiduguri
Résumé
Introduction: L’incidence des tumeurs malignes hématologiques a été démontrée variant selon le sexe, l’âge, la région géographique et le sous-type histologique; tandis que le taux de guérison peut varier selon les régions et peut être affectée par la disponibilité des traitements et l’accès aux soins. L’objectif était d’étudier le spectre de tumeurs malignes hématologiques, la fréquence de survie des lymphomes chez les adultes dans cette région et de comparer nos résultats à des études rapportées ailleurs.
Méthodologie: Il s’agissait d’une étude basée sur l’institution de données du service des archives médicales, l’unité d’hématologie et de greffe de Cancer du Département histopathologie de l’hôpital universitaire de Maiduguri entre Janvier 1998 et Décembre 2011.
Résultats: Les résultats des tumeurs malignes hématologiques représentaient 6,05% de tous les cas de cancer observés et 0,31% des admissions à l’hôpital. Parmi les tumeurs malignes hématologiques, le lymphome non-hodgkinien (LNH) est le plus fréquent, constituant 51,3% tandis que d’autres étaient constitués de lymphome (HL), 26,7% chronique de leucémie myéloïde (LMC), de 5,5%, une leucémie aiguë myéloblastique (LAM), 4,2% Le myélome multiple (MM), 4,2% la leucémie lymphoblastique aiguë (LLA) de 3,8%, la leucémie lymphoïde chronique (LLC), 3,4% syndrome myélodysplasique (MDS), 0,4% et myélofibrose chronique de 0,4%. Les tumeurs malignes hématologiques sont plus fréquentes dans le groupe d’âge plus jeune et aussi plus fréquent chez les hommes que chez les femmes. Les lymphomes sont particulièrement fréquents chez les jeunes adultes et l’incidence tend à diminuer après 70 ans. De même, l’incidence de l’âge bimodale caractéristique pour HL trouvé dans le monde occidental n’a pas été observée dans cette étude. Les deux sous-types histologiques LNH et HL sont similaires aux fréquences signalés ailleurs. Le taux de défaut était et nous avons trouvé une forte corrélation entre les cycles de chimiothérapie données et la survie chez les patients atteints de lymphome. En conclusion, Cette étude a montré que les tumeurs malignes hématologiques ne sont pas rares dans notre environnement.
Conclusion: Il est nécessaire de fournir des installations et la formation d’immunophénotypage et immunohistochimie dans tous les centres de traitement du cancer à travers le pays. Egalement les médicaments cytotoxiques doivent être subventionnés et également être facilement accessibles à tous les patients atteints de tumeurs malignes hématologiques
Correspondence: Dr. M.B. Kagu, Department of Haematology, University of Maiduguri Teaching Hospital, Maiduguri, PMB 1414, Maiduguri, Nigeria. E-mail: bmk449@yahoo.com, bmk449@gmail.com
Referințe
Rogena EA, De Falco G, Schurfeld K and LeonciniL. A review of the trends of lymphomas in the equatorial belt of Africa. Hemato Oncol 2011; 29: 111-115.
Zucca E, Rohatiner A, Magrath I and Cavalli F. Epidemiology and management of lymphoma in low-income countries. Haematol Oncol 2011; 29: 1-4.
Sant M, Allemani C,Tereanu C, De Angelis R, et al. Incidence of Haematologic Malignancies in Europe by Morphologic Subtype; results of HAEMACARE project. Blood 2010; 116 (19): 3724-3734.
Curado MP, Edwards B and Shin HR. Cancer incidence in five continents Vol.9. Lyon, France: IARC Press; 2007: 160.
Ferlay J, Bray F, Pisani P and Parkin DM. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide IARC CancerBase NO.5 Version 2.0 Lyon, France: IARC Press 2004.
Morton LM, Wang SS, Devesa SS, Hartge P,et al. Lymphoma incidence patterns by WHO subtypes in the United States, 1992-2001. Blood, 2006; 107 (1): 265-276.
Liu S, Semenciw R and Mao Y. Increasing incidence of non-Hodgkin’s lymphoma in Canada, 1970-1996: age-period-cohort analysis. Haematol Oncol 2003; 21: 57-66.
Seow A, Lee J, Sng I, Fong CM and Lee HP. Non-Hodgkin’s lymphoma in an Asian population: 1968-1992 time trends and ethnic differences in Singapore. Cancer 1996; 77: 1899-904
Luminari S, Cesaretti M, Rashid I, et al. Incidence, clinical characteristics and survival of malignant lymphomas: a population-based study from a cancer registry in northern Italy. Haematol Oncol 2007; 25: 189-197.
Allemani C, Sant M, De Angelis R, et al. Hodgkin disease survival in Europe and the U.S.: prognostic significance of morphologic groups. Cancer 2006; 1007 (2): 352-360.
Broccia G, Cocco P and Casula P. Incidence of non-Hodgkin’s lymphoma and Hodgkin’s disease in Sardinia, Italy: 1974-1993. Haematological 2001; 86 (1): 58-63.
Zsofia M, Katalin K, Judit V and Gyorgy S Arpad. What is the Price of survival in Hodgkin’s lymphoma? Long-term follow-up of cured patients. Haematol Oncol 2007 Dec; 25: 178-183.
Deirdre PC, Linda CH, Limin XC, Jennifer LS,et al. Patterns of care in a population-based random sample of patients diagnosed with non-Hodgkin’s lymphoma. Haematol Oncol 2005; 23: 73-81.
Swerdlow SH, Campo E, Harris NL, et al. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2008.
Jaffe ES, Harris NL, Stein H and Vardiman JW, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001.
Abiola SB, Chriastian EA, Philip OO and Idayat AD. Pattern of Haematological Malignancies in Ilorin, Nigeria: A Ten Year Review. The Internet Journal of Haematology. 2009; Volume 5 Number 2.
Kagu BM, Durosinmi MA, Adeodu OO, et al. Determinants of Survival in Nigerians with Burkitt’s Lymphoma. Afr J Med Med Sci. 2004; 33: 195-200.
Omoti CE and Halim NKD. Adult Malignant Lymphomas in University of Benin Teaching Hospital, Benin City, Nigeria- Incidence and Survival. Niger J Clin Pract. 2007; 10 (1): 10-14
Williams CKO. Neoplastic diseases of the haemopoietic system in Ibadan: preliminary report of a prospective study. Afr J Med Med Sci. 1985; 14: 89-94.
Williams CKO. Epidemiology of childhood leukaemias and lymphomas with special reference to Ibadan. Nig J Paed. 1985; 12 (1): 1-9.
Essien EM. Leukaemia in Nigerians. I: The acute leukaemias. Afr J Med Med Sci 1972; 3: 117-130.
Shamebo M. Acute Leukaemias in adult Ethiopians in a teaching hospital. Ethiop Med J. 1994; 32 (1): 17-25.
Shamebo M and Gebremedhin A. Chronic lymphocytic leukaemia in Ethiopians. East Afr Med J. 1996; 73 (10) : 643-646.
Oladipupo Williams CK and Bamgboye EA. Estimation of incidence of human leukaemia sub-types in an urban African population. Oncology. 1983; 40: 381-386.
Salawu L and Durosinmi MA. Myelomatosis: clinical and laboratory features in Nigerians. West Afr J Med 2005; 24(1): 54-57.
Onwasigwe CN, Aniebue PN and Ndu AC. Spectrum of paediatric malignancies in eastern Nigeria (1989-1998). West Afr J Med. 2002; 21 (11): 31-33.
Akang EE. Tumors of Childhood in Ibadan, Nigeria (1973-1990). Paediatr Pathol Lab Med. 1996; 16 (5): 791-800.
Rosenberg SA, Berard CW and Brow Jr. National Cancer Institute Sponsored Study of Classifications of non-Hodgkin’s lymphoma: Summary and description of a working formulation for clinical usage. The Non-Hodgkin’s lymphoma Pathologic classification Project. Cancer. 1982; 49: 2112-2135.
Carbone PP, Kaplan HS, Musshaft K et al. Report of the committee on Hodgkin’s disease Staging Classification. Cancer. Res 1971; 31: 1860-1861.
Lister TA, Crowther D, Sutcliffe SB et al .Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol 1989; 7: 1630-1636.
Barbara JB and Lewis SM. Preparation and Staining methods for blood and marrow films In: Dacie and Lewis Practical Haematology 10th Ed, Churchill Livingstone. 2007; Pp 58-64.
Bennett JM, Catovsky D, Daniel M et al. Proposals for the classification of the acute leukaemias. French-American-British (FAB) cooperative group. Br J Haematol. 1976; 33: 451-458.
Bennett JM, Catovsky D, Daniel M et al. Proposals for the classification of chronic (mature) B and T lymphoid leukaemias. French-American- British (FAB) cooperative group. J. Clin Pathol. 1989; 42: 567-584.
Broccia G, Deplano W, Dessalvi P et al. Hematological Malignancies in the island of Sardinia, 1974-1993: Age and Sex distributions and temporal changes in incidence. Haematol Oncol 2004; 22: 91-109.
Naresh KN, Agarwal B, Nathwani BN et al. Use of the World Health Organization (WHO) classification of non-Hodgkin’s lymphoma in Mumbai, India: a review of 200 consecutive cases by a panel of five expert haematopathologists. Leuk Lymphoma 2004; 45: 1569-1577.
Adelusola KA, Adeneji KA and Somotun GO. Lymphoma in adult Nigerians. WAJM 2001; 20(2): 123-126.
Okpala IE, Akang EE and Okpalla UJ. Lymphoma in University College Hospital, Ibadan, Nigeria Cancer 1991; 68: 1356-1360.
Peh SC, Shaminie J, Jayasurya P et al. Spectrum of malignant lymphoma in Queen Elizabeth Hospital, Sabah. Med J Malasia 2003; 58 (4): 546-555.
Baris D and Zahm SH. Epidemiology of Lymphomas. Curr Opin Oncol 2000; 12 (5): 383-394.
van den Bosch CA. Is endemic Burkitt’s lymphoma an alliance between three infections and a tumour promoter? Lancet Oncol. 2004; 5: 738-746.
Cartwright RA and Watkin’s G. Epidemiology of Hodgkin’s disease: A review. Hematol Oncol 2004: 22: 11-26.
Deninger MW and Druker BJ. Specific Targeted Therapy of Chronic Myelogenous Leukaemia with Imatinib. Pharmacol Rev. 2003; 55: 401-423.
Durosinmi MA, Faluyi JO, Oyekunle AA et al. The use of Imatinib in Nigerians with chronic myeloid leukaemia. Cell Ther Transplant 2008; 1: e. 000027.01.doi:10.3205/ctt-2008-en-000027.01
Boma PO, Durosinmi MA, Adediran IA et al. Clinical and prognostic features of Nigerians with chronic myeloid leukaemia. Niger Postgrad Med J. 2006; 13: 47-52.
Okany CC and Akinyanju OO. Chronic leukaemia: an African experience. Med Oncol Tumor Pharmacother. 1989; 6: 189-194.
Alao OO, Bazuaye GN, Halim NKD and Omoti CE. The Epidemiology of Haematological Malignancies at the University of Benin Teaching Hospital: A Ten-Year Retrospective Study. The Internet Journal of Epidemiology. 2011; Volume 9 Number 2. DOI: 10.5580.1fbb.
Reodaelli A, Stephen JM, Laskin BL, et al. Botteman MF. The burden and Outcome Associated with Four Leukaemias: AML, ALL, CLL, and CML. Expert Rev Anticancer Ther 2003; 3(3): 311-329.
Watson L, Wyld P and Catovsky D. Disease burden of chronic lymphocytic leukaemia within the European Union. Eur J Haematol 2008; 81 (4): 253-258.
Colby TV, Hoppe RT and Warnke RA. Hodgkin’s disease: A clinicopathological study of 659 cases. Cancer. 1982; 49: 1848-1858.
Lee SC, Wong JE and Kuch YK. Clinical characteristics and treatment outcome of 218 patients with non-Hodgkin’s lymphoma in a Singaporean institution. Singapore Med J 2000; 41 (3): 118-121.
Diop S, Deme A, Dangou JM. et al. Non-Hodgkin’s Lymphoma in Dakar: study of 107 cases diagnosed between 1986 and 1998. Bull Soc Pathol Exot 2004; 97 (2): 109-112.
Emoti CE and Enosolease ME. The effect of accessibility to drugs on the outcome of therapy in patients with malignant lymphoma. Niger Postgrad Med J 2008; 15: 10-14.