Date Published: May 28, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Aïssata Tolo Diebkilé, Boidy Kouakou, Emeraude N’dhatz, Clotaire D. Nanho, N’Dogomo Meité, Roméo Ayémou, Mamadou Y. Sekongo, Paul Kouéhion, Mozart Konan, Gustave K. Koffi, Ibrahima Sanogo.
Diffuse large B-cell lymphomas have been little studied in black Africans. The purpose of our study was to determine the characteristics and results of the management of these lymphomas. Patients and Methods. In a descriptive and analytic retrospective study we studied the medical records of 63 patients with diffuse large B-cell lymphoma hospitalized during the period from 1991 to 2007. The diagnosis was made after lymph node or organ biopsy. Response to treatment, OS, PFS, and toxicity were studied. The complete response has been analyzed univariate and multivariate analysis. Results. The median age was 42 years. The sex ratio was 2. The HIV serology was positive in 11 cases, and 8 patients had antiretroviral therapy. In 71% the lymphoma was at stages III and IV of Ann Arbor. IPI was ≥3 in 65%. Complete remission was achieved in 43%. Only 43% of patients had had a good compliance. Progression-free survival at 3 years was 32%, and overall survival at 3 years was 50%. 13% of patients were lost to follow up, and 51% of them died. In terms of analysis the complete remission rate was influenced by the stage of Ann Arbor (P < 0.0001), biological b symptoms (P < 0.01), the IPI (P < 0.0001), and the socioeconomic standing (P = 0.001). In multivariate analysis, only IPI and stage of Ann Arbor influence the complete remission.
Diffuse large B-cell lymphomas are clonal proliferations of B-lymphocytes. It is the most common form of non-Hodgkin’s lymphomas accounting for 30 to 40% of lymphomas in adults [1, 2]. They are aggressive because the cells are young and express the proliferation marker Ki 67+. Thus, the doubling of the tumor mass is rapid, in the order of 15 days to one month. Diffuse large B-cell lymphomas constitute a heterogenous group with at least 15 entities according to the 2008 World Health Organization (WHO) classification and two molecular subtypes: those of germinal center type and those of activated B-cells type [3, 4]. These lymphomas may originate in the lymph nodes or in extranodal sites; they can be localized or disseminated.
Our study was carried out in the Department of Clinical Hematology of Yopougon Teaching Hospital of Abidjan, Côte d’Ivoire from July 1991 to September 2007. Patients hospitalized with diffuse large B-cell lymphoma of histological and immunohistochemical diagnosis (CD 19, CD 20, CD 22, and CD 79a) after lymph node or organ biopsy, with a complete medical record and who received CHOP protocol for treatment. Diffuse large B-cell lymphomas after transformation of a follicular lymphoma and primitive diffuse large B-cell lymphomas of the central nervous system were excluded. Sixty-three records were selected. The study was retrospective, descriptive, and analytic. Each medical record was operated using a survey form. The collection of data in the record looked for epidemiological parameters: age, sex, socioeconomic standing, and history of exposure to known etiologic factors. The clinical status took into account the general condition (weight loss, profuse night sudation, fever, and index of the activity of the WHO) as well as the various devices in the search for tumor lesion or other. Para-clinically, a lymph node or organ biopsy with pathological examination was performed. In each patient a cervicothoracic and abdominopelvic computed tomography (CT scan), a bone marrow biopsy, a lumbar puncture with cytological study of the cerebrospinal fluid, a check-up of biological course (blood count, fibrinemia, LDH, β2 microglobulin, protein electrophoresis, serum electrolytes, uric acid) and a pretherapeutic check-up (liver and kidney check-up, echocardiography, HIV status, and B and C viral serology) were performed. In terms of therapy, chemotherapy with CHOP protocol was assessed (6 to 9 cycles were planned) and prognostic factors were identified by univariate and multivariate analysis of the therapeutic response.
In our study, patient’s median age was 42 years with extremes of 12 and 75 years. Diffuse large B-cell lymphoma can occur at any age but most patients were less than 60 years. The median age of discovery is, however, variable depending on subtypes, on an average of 58 years for the forms of the germinal center, 66 years for the activated forms, and 35 years for mediastinal forms .
Diffuse large B-cell lymphoma in black Africans presents some epidemiological, clinical, therapeutic, and prognostic particularities: the age of onset is lower, the disease is more disseminated (stages III and IV of Ann arbor), the complete remission rate is low, the socioeconomic standing constitutes a significant prognostic factor, and some patients are lost to follow up.