Type E – Dr Gisela Kahl – Single-centre Experience of B-cell Lymphomas in Children at the Height of the HIV Epidemic in South Africa
A travel grant was awarded to Dr Gisela Kahl from Red Cross Children’s Hospital to attend and present a poster at the 6th International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma in Rotterdam from 26 to 29 September 2018.
The major areas of study and how the visit have contributed to the understanding and/or management of cancer
Single-centre experience of B-cell lymphomas in children at the height of the HIV epidemic in South Africa
Haematology/Oncology Unit, Red Cross Children’s Hospital
South Africa has seen an increase in B-cell lymphomas (BCL) associated with HIV/AIDS, Burkitt lymphoma (BL), the most common subtype, occurs mostly in the sporadic form in South Africa.
The purpose of this study was to evaluate the outcome of children with BCL, with and without HIV infection, assess the most common histology, and to determine whether the HIV epidemic has increased the incidence of BCL.
The study was a retrospective folder review of patients with BCL at Red Cross Children’s Hospital, Cape Town, between January 2003 and December 2015.
Ninety-eight patients were diagnosed with BCL with a median age of 6.41 years. 69 patients were HIV-negative, and 29 patients were HIV-positive. The annual incidence of BCI, in the HIV-negative group was 4.3 vs 5.3 cases per year for 1991-2002 and 2003-2015, respectively. In the latter period, 2.2 additional cases of BCL were diagnosed in HIV-positive children. In the HIV-positive group.19 (66%) had BL, 7 (24%) had Diffuse Large B-cell Lymphoma (DLBCL), 3 (10%) had other subtypes of BCL. Twelve (41%) were on antiretroviral therapy at diagnosis. Seven HIV-positive patients were not treated with chemotherapy due to poor performance status, parent refusal or post-mortem diagnosis. In the HIV-positive group, one patient was in LMB risk Group A (3%), 19 patients in Group B (65%) and 8 patients in Group C (28%). One patient had a primary CNS lymphoma. In the HIV-negative group, 8 patients were in Group A (12%), 38 patients in Group B (55%), and 23 patients in Group C (33%). Overall 5-year event free survival was 81%; specifically, HIV-negative group: 84% (n=69) and HIV-positive group; 70% (n=22). Survival rates were not significantly different between the HIV-positive and negative groups for Group B and C (p-value 0.20 and 0.37 respectively).
The outcomes for HIV-positive children with BCL were not significantly worse than the survival of HIV-negative children in the same time period. Although BL was the most common subtype overall for both the HIV-positive and negative group, DLBCL was proportionally more common in the HIV-positive group. The HIV epidemic has produced a modest increase in the incidence of BCL.