Improving Cure for Lymphoma Patients in South Africa by Enhancing Access to Early and Accurate Lymphoma Diagnosis
A/Prof Estelle Verburgh
Title of the project
Improving cure for lymphoma patients in South Africa by enhancing access to early and accurate lymphoma diagnosis
Non-Hodgkin lymphoma is the seventh most common cancer in South Africa, sixth when Hodgkin and non-Hodgkin lymphoma are combined. Lymphoma is the leading cancer-specific cause of mortality in persons with HIV.
Lymphoma can be challenging to diagnose, owing to the insidious onset of symptoms, difficulties in obtaining a lymph node biopsy, and, in a TB-endemic setting is often misdiagnosed as extrapulmonary TB due to overlapping symptoms and unfocused investigations. Delayed diagnosis of lymphoma leads to inferior treatment outcomes.
There are over 80 subtypes of lymphoma in the WHO classification. Early and accurate diagnosis of the aggressive lymphoma subtypes is especially challenging in low-resource settings, owing to diagnostic delays, cost, and shortage of skilled pathologists. The current standard for lymphoma subtype characterization requires expensive specialized methods, including immunohistochemistry and fluorescent in situ hybridization. These subset distinctions are essential for accurate epidemiological reporting and guiding treatment. Our collaborators at the Dana-Farber Cancer Institute (DFCI, Harvard) are developing a novel genetic assay that has the potential to transform diagnosing lymphoma in the low-middle income country (LMIC) setting. The assay uses chemical ligation-based probe amplification (CLPA) to quantify the expression of 37 genes by capillary electrophoresis to accurately predict lymphoma subtype. This test costs <$10/sample but currently is untested in TB-endemic settings and in HIV-associated lymphoma subtypes.
The main objectives of this project are to address the two biggest obstacles to lymphoma diagnosis in our setting: 1) To implement and validate, at primary and secondary care level, the diagnostic performance and cost-effectiveness of the diagnostic algorithm that we have developed, and 2) To develop a low-cost second-generation gene expression assay for lymphoma subsets that is able to differentiate subtypes of lymphoma and other causes of lymphadenopathy, including TB.
This will be a major advance for Sub-Saharan Africa and other LMICs facing similar diagnostic obstacles.