Improving Cure for Lymphoma Patients in South Africa by Enhancing Access to Early and Accurate Lymphoma Diagnosis
A/Prof Estelle Verburgh
Project ended 30 May 2025
A/Prof Estelle Verburgh
- Clinical Haematology, Department of Medicine, University of Cape Town
Title of the project
Improving cure for lymphoma patients in South Africa by enhancing access to early and accurate lymphoma diagnosis
Project Description
The incidence of aggressive lymphoma is markedly elevated in people living with HIV (PLWH) and in South Africa the rate is almost three times higher than the global average. Even on anti-retroviral therapy, PLWH are still approximately 10 times more likely to develop Hodgkin lymphoma (HL) and aggressive non-Hodgkin lymphoma (aNHL) and at a younger age. Epidemiological date on lymphoma in the Southern African population is scarce due to a lack of high quality, population-based cancer registries. HL and aNHL make up most cases in our setting and delayed diagnosis leads to advanced stage and poor outcomes.
Lymphoma may be misdiagnosed as TB because the two diagnoses share similar symptoms, clinical characteristics, and investigation findings. In TB-endemic areas, it is reported that up to 85% of patients with lymphoma are on presumptive TB treatment at the time of diagnosis of lymphoma. Lymphoma diagnosis is frequently delayed due to obstacles in obtaining a lymph node biopsy. An excision biopsy, a surgical procedure to remove the entire lymph node, is time-consuming, requires surgical expertise, and carries anaesthetic and surgical risks. A core-biopsy, a procedure which takes a small sample of the lymph node using a needle, is a minimally invasive technique that has been successful in diagnosing the cause of lymphadenopathy in our setting. Our first aim of the project is to educate and train healthcare workers to perform core needle biopsies in order to make timely and accurate diagnoses that will improve outcomes. We will also assess the cost-effectiveness of the core biopsy compared to the excision biopsy.
Once a tissue sample has been obtained from the lymph node, pathological expertise and expensive ancillary tests are required to make a diagnosis of lymphoma. Access to these techniques is limited by cost and a shortage of trained biology pathologists in the region. Accurately distinguishing lymphoma subsets is essential to improve epidemiological reporting, enrolment in clinical trials and therapeutic management.
Our collaborators at Dana-Farber Cancer Institute developed a low-cost genetic test that analyses the expression of genes (CLPA assay) in lymph node tissue to identify the most-likely and second mostlikely subcategory of lymphoma (or non-lymphoma). However, the unique diagnostic challenge of HIVassociated lymphoma has not been assessed with this strategy. We will investigate this novel platform for reliable implementation in an HIV and TB-endemic setting. Additionally, this technology can also be used to differentiate between TB, other cancers, and benign lymphadenopathy. Our second aim of the project is to develop a low-cost second-generation gene expression assay for accurate and affordable diagnostics of lymph node specimens in LMIC settings.
How this project contributed towards cancer research in South Africa and elsewhere
- The diagnostic pathway research and training for patients with lymphadenopathy due to TB, lymphoma and other cancers will greatly influence the clinical practice of clinicians nation-wide.
- The establishment RADLAC sites will continue to generate valuable data that will contribute to future research projects in the field of diagnostic pathways in lymphoma and other cancers.
- Publications have highlighted the importance of discriminating cancer from TB diagnosis in multiple clinical settings.
- Training of research staff and students has strengthened local cancer research capacity Involvement in the CLPA1 project has contributed to the development of a global network of sites which will allow for creation of a new assay with greater potential for diagnostic utility.
