Case series of Nodular Lymphocyte Predominant Hodgkin Lymphoma from Tanzania. A common entity in East Africa?
NLPHL is a rare subtype of HL and constitutes to approximately 5% of all HL, hence less than 0.5% of all lymphomas [1,2]. For Sub-Saharan Africa, publications about NLPHL are literally non existing. Due to the rarity of NLPHL, clinical trial data are limited, but NLPHL are generally associated with good prognosis [3,4]. Due to the CD20 positivity, the use of CD20-antibodies is recommended and contributes to a good treatment outcome according to publications from high income countries.
As treatment outcome and patient’s characteristics from African NHLP patients have not been reported as of today, we therefore display patient’s characteristics, treatment outcome and follow up from a sub-cohort of Tanzanian patients enrolled in a multi-centre study in Uganda and Tanzania focusing on EBV-driven lymphoma, the AI-REAL study .
An observational descriptive case series, assessing the clinical presentation, stage, treatment and results of treatment of patient recruited through the AL-REAL  study at Kilimanjaro Christian Medical Centre site.
Out of 55 children and young adults (between 3 to 30 years of age) who were diagnosed with lymphoma, 17 had HL and 6 out of these had NLPHL. Mean age was 19.5 years (range 3-28), sex ratio 1:1, 5 presented with B symptoms, 4 were in stage III and 2 in stage I. IHC for CD20 were available in 5 patients (all positive). In the first line therapy, 2 paediatric patients received ABVD and R-ABVD, the adult patients received R-CHOP (2 cases), CHOP (1), and surgery only (1). For all patients receiving chemotherapy, 6 cycles were given. 5 patients achieved CR, and 1 patient progressed on 1st (ABVD) and 2nd (R-CHOEP) line and eventually died. Treatment outcome was assessed 2 weeks after the last cycle of chemotherapy (respectively surgery) by CT scan, the cumulative survival months up to June 2022 is 90 months, ranging from 10 to 24 months after finalizing therapy.
This case series demonstrate a high proportion of NLPHL among the study population. Further studies should evaluate the frequency of NLPHL in the Sub-Saharan setting. With 5 out of 6 patients achieving CR (1 after 2nd line), the favorable treatment outcome described in other settings can be confirmed for Tanzania.