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Open Access Highly Accessed Research article

Immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients, Kampala, Uganda

Lynnette K Tumwine1*, Claudio Agostinelli2, Cristina Campidelli2, Emmanuel Othieno1, Henry Wabinga1, Simona Righi2, Brunangelo Falini3, Pier Paolo Piccaluga2, Wilson Byarugaba1 and Stefano A Pileri2

Author affiliations

1 Department of Pathology, Makerere University, College of Health Sciences, PO Box 7072, Kampala, Uganda

2 Unit of Hematopathology, Department of Haematology and Oncological Sciences "L and A Seràgnoli"/Interdepartmental Centre for Cancer Research "G Prodi", Bologna University School of Medicine, Bologna, Italy

3 Laboratory of Haematopathology, Institute of Haematology, Perugia University School of Medicine, Perugia, Italy

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Citation and License

BMC Clinical Pathology 2009, 9:11  doi:10.1186/1472-6890-9-11

Published: 16 December 2009

Abstract

Background

Non Hodgkin lymphomas are the most common lymphomas in Uganda. Recent studies from developed countries have shown differences in survival for the different immunophenotypes. Such studies are lacking in Africa where diagnosis is largely dependent on morphology alone. We report immunohistochemical and other prognostic factors in B cell non Hodgkin lymphoma patients in Kampala, Uganda.

Methods

Non Hodgkin lymphoma tissue blocks from the archives of the Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda, from 1991-2000, were sub typed using haematoxylin and eosin, Giemsa as well as immunohistochemistry. Using tissue micro array, 119 biopsies were subjected to: CD3, CD5, CD10, CD20, CD23, CD30, CD38, CD79a, CD138, Bcl-6, Bcl-2, IRTA-1, MUM1/IRF4, Bcl-1/cyclin D1, TdT, ALKc, and Ki-67/Mib1. Case notes were retrieved for: disease stage, chemotherapy courses received and retrospective follow up was done for survival.

Results

Non Hodgkin B cell lymphomas comprised of Burkitt lymphoma [BL] (95/119) diffuse large B cell lymphoma (19/119), mantle cell lymphoma (4/119) and precursor B lymphoblastic lymphoma (1/119).

For Burkitt lymphoma, good prognosis was associated with receiving chemotherapy, female gender and CD30 positivity. Only receiving chemotherapy remained significant after Cox regression analysis. Diffuse large B cell lymphomas with activated germinal centre B cell (GCB) pattern (CD10+/-, BCL-6+/-, MUM+/-, CD138+/-) had better survival (98.4 months; 95% CI 89.5 -107.3) than the others (57.3 months; 95% CI 35.5 - 79.0) p = 0.027 (log rank test).

Conclusions

Activated GCB diffuse large B cell lymphoma had a better prognosis than the others. For Burkitt lymphoma, not receiving chemotherapy carried a poor prognosis. Availability of chemotherapy in this resource limited setting is critical for survival of lymphoma patients.