Hodgkin’s lymphoma (HL) is a lymphoproliferative disorder that was first described by Thomas Hodgkin and Samuel Wilks in the first half of the nineteenth century. It is characterised by the presence of painless lymphadenopathy, usually in the cervical region. Constitutional symptoms are a common presenting feature. Clinical staging is based on the backbone of the Ann Arbor staging classification. Patients with advanced disease often have hepatosplenomegaly and bone marrow infiltration. True extranodal disease is rare. HL is broadly divided into two distinct clinical entities: nodular lymphocyte predominant HL (5%) and classical HL (95%) - which is further subdivided into four groups: nodular sclerosis HL, mixed cellularity HL, lymphocyte-rich HL and lymphocyte-depleted HL. Most patients are treated with combination chemotherapy and involved field radiotherapy. With excellent cure rates of >95% for early stage disease nowadays, the challenge is to minimise the adverse long term effects of chemo-radiotherapy, while at the same time achieving optimal cure rates.
There are clear differences in the demographics and clinical presentation of HL between the developed world and developing countries. Hence, the main aim of this study was to determine the demographics and clinical presentation of HL in a developing, sub-Saharan African population, and to compare these findings with findings elsewhere in the world. Secondary objectives included assessing the treatment used and response to therapy, prognostic factors affecting survival, differences in the presentation between human immunodeficiency virus (HIV) positive and negative individuals, the association of HL with tuberculosis, and the documentation of the long term effects of therapy.
Method: This was a retrospective review of all adult patients diagnosed with HL at Chris Hani-Baragwanath Hospital (CHBH) in Soweto during the period January 1990 – December 2004. Results: 163 patients were seen over a fifteen year period. There were 93 males and 70 females, with a Male(M):Female(F) ratio of 1.3:1. The median age at presentation was 29yrs, with an absence of a second peak in older patients. Seventy eight percent of patients had B symptoms and 69% had advanced stage disease at presentation. Nodular sclerosis HL was the main histological subtype in the younger, HIV negative population. Mixed cellularity HL was the commonest histological subtype seen in older patients and the HIV positive group. Sixty three percent of patients had a complete response to first line therapy, 18% a partial response, 2% stable disease and 17% progressive disease. Prognostic features of statistical significance that negatively affected survival included older patients (>40yrs), patients with advanced stage disease and HIV seropositivity. The histological subtype and presence of B symptoms did not significantly affect outcome. Twenty three percent of the patients were HIV positive, and increasing seropositivity appears to be an emerging trend. Conclusion: HL in patients at CHBH displays many clinical characteristics typical of a developing nation, such as the absence of a bimodal age distribution, more B symptoms and more advanced stage disease. The predominance of the more favourable nodular sclerosis histological subtype in the younger, HIV negative population tends to follow the pattern of a developed nation. Older patients, patients with advanced stage disease and HIV positive patients have a poorer outcome. The large number of patients lost to follow up precludes accurate assessment of long term overall survival in the study population, as well as documentation of long term adverse effects/complications of therapy.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/12627 |
| Date | 05 April 2013 |
| Creators | Fazel, Fatima Bibi |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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