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51. ‘Discovering’ primary effusion lymphoma in Malawi

Author

Dhungel, Bal Mukunda, Montgomery, Nathan D., Painschab, Matthew S., Mulenga, Maurice, Tomoka, Tamiwe, Kaimila, Bongani, Zuze, Takondwa, Kasonkanji, Edwards, Kampani, Coxcilly, Chimzimu, Fred, Randall, Cara, Krysiak, Robert, Seguin, Ryan, Fedoriw, Yuri, and Gopal, Satish

Published
2018
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52. HIV Viremia and Incidence of Non-Hodgkin Lymphoma in Patients Successfully Treated With Antiretroviral Therapy

Author

Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS), Achenbach, Chad J., Buchanan, Ashley L., Cole, Stephen R., Hou, Lifang, Mugavero, Michael J., Crane, Heidi M., Moore, Richard D., Haubrich, Richard H., Gopal, Satish, Eron, Joseph J., Hunt, Peter W., Rodriguez, Benigno, Mayer, Kenneth, Saag, Michael S., and Kitahata, Mari M.

Published
2014
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54. Plasmablastic lymphoma in Malawi

Author

Zuze, Takondwa, Painschab, Matthew S., Seguin, Ryan, Kudowa, Evarista, Kaimila, Bongani, Kasonkanji, Edwards, Tomoka, Tamiwe, Dhungel, Bal Mukunda, Mulenga, Maurice, Chikasema, Maria, Tewete, Blessings, Ntangwanika, Asekanadziwa, Chiyoyola, Sarah, Chimzimu, Fred, Kampani, Coxcilly, Krysiak, Robert, Montgomery, Nathan D., Fedoriw, Yuri, and Gopal, Satish

Published
2018
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56. Tobacco and other risk factors for esophageal squamous cell carcinoma in Lilongwe Malawi: Results from the Lilongwe esophageal cancer case: Control study

Author

Kaimila, Bongani, primary, Mulima, Gift, additional, Kajombo, Chifundo, additional, Salima, Ande, additional, Nietschke, Peter, additional, Pritchett, Natalie, additional, Chen, Yingxi, additional, Murphy, Gwen, additional, Dawsey, Sanford M., additional, Gopal, Satish, additional, Phiri, Kamija S., additional, and Abnet, Christian C., additional

Published
2022
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59. The 10th Annual Symposium on Global Cancer Research: New Models for Global Cancer Research, Training, and Control

Author

Jallow, Fatou, primary, Bourlon, Maria Teresa, additional, Cira, Mishka Kohli, additional, Duncan, Kalina, additional, Eldridge, Linsey, additional, Elibe, Erinma, additional, Estes, Taylor, additional, Frank, Allison, additional, Gravitt, Patti, additional, Llera, Andrea Sabina, additional, Moucheraud, Corrina, additional, Mulherkar, Rita, additional, Musonda, Webster, additional, Ogembo, Javier Gordon, additional, Pearlman, Paul, additional, Phiri, Sam, additional, Sivaram, Sudha, additional, Stern, Mariana, additional, and Gopal, Satish, additional

Published
2022
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63. Clinical Characteristics of Incident Lymphoma in Malawi before and after Implementation of Universal Anti-Retroviral Therapy

Author

Gondwe, Yolanda, primary, Kudowa, Evaristar, additional, Tomoka, Tamiwe, additional, Randall, Cara, additional, Lilly, Amy, additional, Kasonkanji, Edwards, additional, Kaimila, Bongani, additional, Zuze, Takondwa, additional, Mumba, Noel, additional, Kimani, Stephen, additional, Mulenga, Maurice, additional, Gopal, Satish, additional, Fedoriw, Yuri, additional, and Painschab, Matthew, additional

Published
2021
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65. Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi

Author

Stanley, Christopher C., Westmoreland, Kate D., Heimlich, Brett J., El-Mallawany, Nader K., Wasswa, Peter, Mtete, Idah, Butia, Mercy, Itimu, Salama, Chasela, Mary, Mtunda, Mary, Chikasema, Mary, Makwakwa, Victor, Kaimila, Bongani, Kasonkanji, Edwards, Chimzimu, Fred, Kampani, Coxcilly, Dhungel, Bal M., Krysiak, Robert, Montgomery, Nathan D., Fedoriw, Yuri, Rosenberg, Nora E., Liomba, George N., and Gopal, Satish

Published
2016
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70. Pediatric lymphoma patients in Malawi present with poor health‐related quality of life at diagnosis and improve throughout treatment and follow‐up across all Pediatric PROMIS‐25 domains

Author

Ellis, Grace K., primary, Chapman, Hutton, additional, Manda, Agness, additional, Salima, Ande, additional, Itimu, Salama, additional, Banda, Grace, additional, Seguin, Ryan, additional, Manda, Geoffrey, additional, Butia, Mercy, additional, Huibers, Minke, additional, Ozuah, Nmazuo, additional, Tilly, Alyssa, additional, Stover, Angela M., additional, Basch, Ethan, additional, Gopal, Satish, additional, Reeve, Bryce B., additional, and Westmoreland, Katherine D., additional

Published
2021
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74. Uptake and safety of community‐based “screen‐and‐treat” with thermal ablation preventive therapy for cervical cancer prevention in rural Lilongwe, Malawi

Author

Chinula, Lameck, primary, Topazian, Hillary M., additional, Mapanje, Clement, additional, Varela, Amanda, additional, Chapola, John, additional, Limarzi, Laura, additional, Stanley, Christopher, additional, Hosseinipour, Mina, additional, Gopal, Satish, additional, and Tang, Jennifer H., additional

Published
2021
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76. High pretreatment plasma Epstein-Barr virus (EBV) DNA level is a poor prognostic marker in HIV-associated, EBV-negative diffuse large B-cell lymphoma in Malawi

Author

Kasonkanji, Edwards, Kamapani, Coxcilly, Kaimila, Bongani, Miller, Melissa B., Zuze, Takondwa, Gopal, Satish, Mulenga, Maurice, Damania, Blossom, Fedoriw, Yuri, Dittmer, Dirk P., Elliott, Avian, Randall, Cara, Painschab, Matthew, Sanders, Marcia K., Seguin, Ryan, Montgomery, Nathan D., Krysiak, Robert, Chimzimu, Fred, and Tomoka, Tamiwe

Subjects
hemic and lymphatic diseases
Abstract

Plasma Epstein-Barr virus (EBV) DNA measurement has established prognostic utility in EBV-driven lymphomas, where it serves as a circulating tumor DNA marker. The value of plasma EBV measurement may be amplified in sub-Saharan Africa (SSA), where advanced imaging and molecular technologies for risk stratification are not typically available. However, its utility in diffuse large B-cell lymphoma (DLBCL) is less certain, given that only a subset of DLBCLs are EBV-positive. To explore this possibility, we measured plasma EBV DNA at diagnosis in a cohort of patients with DLBCL in Malawi. High plasma EBV DNA at diagnosis (≥3.0 log10 copies/mL) was associated with decreased overall survival (OS) (P =.048). When stratified by HIV status, the prognostic utility of baseline plasma EBV DNA level was restricted to HIV-positive patients. Unexpectedly, most HIV-positive patients with high plasma EBV DNA at diagnosis had EBV-negative lymphomas, as confirmed by multiple methods. Even in these HIV-positive patients with EBV-negative DLBCL, high plasma EBV DNA remained associated with shorter OS (P =.014). These results suggest that EBV reactivation in nontumor cells is a poor prognostic finding even in HIV-positive patients with convincingly EBV-negative DLBCL, extending the potential utility of EBV measurement as a valuable and implementable prognostic marker in SSA.

Published
2020
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77. Cancer trials in sub-Saharan Africa: Aligning research and care

Author

Gopal, Satish

Subjects
Cancer treatment -- Research, Clinical trials -- Analysis, Biological sciences
Abstract

Author(s): Satish Gopal 1,2,3,4,5,6,* Summary points There is an extreme scarcity of evidence to guide cancer treatment in sub-Saharan Africa (SSA), as well as major differences between SSA and resource-rich [...]

Published
2017
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80. Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis, and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains.

Author

Ellis, Grace, primary, Chapman, Hutton, additional, Manda, Agness, additional, Salima, Ande, additional, Itimu, Salama, additional, Banda, Grace, additional, Seguin, Ryan, additional, Manda, Geoffrey, additional, Butia, Mercy, additional, Huibers, Minke, additional, Ozuah, Nmazuo, additional, Tilly, Alyssa, additional, Stover, Angela, additional, Basch, Ethan, additional, Gopal, Satish, additional, Reeve, Bryce, additional, and Westmoreland, Kate, additional

Published
2020
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81. Clinical Trials for Treatment and Prevention of HIV-Associated Malignancies in Sub-Saharan Africa: Building Capacity and Overcoming Barriers

Author

Lin, Lilie L., primary, Lakomy, David S., additional, Chiao, Elizabeth Y., additional, Strother, Robert M., additional, Wirth, Meg, additional, Cesarman, Ethel, additional, Borok, Margaret, additional, Busakhala, Naftali, additional, Chibwesha, Carla J., additional, Chinula, Lameck, additional, Ndlovu, Ntokozo, additional, Orem, Jackson, additional, Phipps, Warren, additional, Sewram, Vikash, additional, Vogt, Samantha L., additional, Sparano, Joseph A., additional, Mitsuyasu, Ronald T., additional, Krown, Susan E., additional, and Gopal, Satish, additional

Published
2020
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82. Challenges of HIV Lymphoma Clinical Trials in Africa: Lessons From the AIDS Malignancy Consortium 068 Study

Author

Strother, Robert M., primary, Gopal, Satish, additional, Wirth, Meg, additional, Chadburn, Amy, additional, Noy, Ariela, additional, Cesarman, Ethel, additional, Lee, Jeannette Y., additional, Remick, Scot C., additional, Busakhala, Naftali, additional, Kaimila, Bongani, additional, Mberi, Elson, additional, Ndlovu, Ntokozo, additional, Omoding, Abrahams, additional, and Krown, Susan E., additional

Published
2020
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83. Feasibility of upfront mobile money transfers for transportation reimbursement to promote retention among patients receiving lymphoma treatment in Malawi

Author

Ellis, Grace K, primary, Manda, Agness, additional, Topazian, Hillary, additional, Stanley, Christopher C, additional, Seguin, Ryan, additional, Minnick, Caroline E, additional, Tewete, Blessings, additional, Mtangwanika, Asekanadziwa, additional, Chawinga, Mena, additional, Chiyoyola, Sara, additional, Chikasema, Maria, additional, Salima, Ande, additional, Kimani, Stephen, additional, Kasonkanji, Edwards, additional, Mithi, Victor, additional, Kaimila, Bongani, additional, Painschab, Matthew S, additional, Gopal, Satish, additional, and Westmoreland, Katherine D, additional

Published
2020
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88. High pretreatment plasma Epstein‐Barr virus (EBV) DNA level is a poor prognostic marker in HIV‐associated, EBV‐negative diffuse large B‐cell lymphoma in Malawi

Author

Montgomery, Nathan D., primary, Randall, Cara, additional, Painschab, Matthew, additional, Seguin, Ryan, additional, Kaimila, Bongani, additional, Kasonkanji, Edwards, additional, Zuze, Takondwa, additional, Krysiak, Robert, additional, Sanders, Marcia K., additional, Elliott, Avian, additional, Miller, Melissa B., additional, Kampani, Coxcilly, additional, Chimzimu, Fred, additional, Mulenga, Maurice, additional, Damania, Blossom, additional, Tomoka, Tamiwe, additional, Fedoriw, Yuri, additional, Dittmer, Dirk P., additional, and Gopal, Satish, additional

Published
2019
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89. Modified EPOCH for high‐risk non‐Hodgkin lymphoma in sub‐Saharan Africa

Author

Zuze, Takondwa, primary, Ellis, Grace K., additional, Kasonkanji, Edwards, additional, Kaimila, Bongani, additional, Nyasosela, Richard, additional, Nyirenda, Ruth, additional, Tomoka, Tamiwe, additional, Mulenga, Maurice, additional, Chikasema, Maria, additional, Tewete, Blessings, additional, Mtangwanika, Asekanadziwa, additional, Chiyoyola, Sarah, additional, Chimzimu, Fred, additional, Kampani, Coxcilly, additional, Mhango, Wilberforce, additional, Nicholas, Simon, additional, Randall, Cara, additional, Montgomery, Nathan D., additional, Fedoriw, George, additional, Westmoreland, Katherine D., additional, Painschab, Matthew S., additional, and Gopal, Satish, additional

Published
2019
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93. High Cancer Burden Among Antiretroviral Therapy Users in Malawi: a Record Linkage Study of Observational HIV Cohorts and Cancer Registry Data

Author

Horner, Marie-Josèphe, Chasimpha, Steady, Spoerri, Adrian, Edwards, Jessie, Bohlius, Julia, Tweya, Hannock, Tembo, Petros, Nkhambule, Franklin, Phiri, Eddie Moffo, Miller, William C, Malisita, Kennedy, Phiri, Sam, Dzamalala, Charles, Olshan, Andrew F, and Gopal, Satish

Subjects
360 Social problems & social services, 610 Medicine & health
Abstract

Background With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS defining cancers are now more frequent among HIV-infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users. Methods We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in the Malawi's two largest HIV cohorts, Lighthouse Trust (LT; 2007-2010) and Queen Elizabeth Central Hospital (QECH; 2000-2010). Age-adjusted cancer incidence rates (IR) and 95% confidence intervals were estimated by cancer site, early versus late incidence periods (4 -24 and >24 months after ART start), and WHO stage among naïve ART initiators enrolled for at least 90 days. Results We identified 4,346 cancers among 28,576 persons. Most people initiated ART at advanced WHO stage (LT stage 3/4: 55%; QECH stage 3/4: 66%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100,000 person-years), followed by cervical cancer (36.6). KS incidence was highest during the early period 4-24 months after ART initiation. Non-AIDS defining cancers (NADC) accounted for 6% of new cancers. Conclusions Under historical ART guidelines, NADC were observed at low rates, and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context.

Published
2019

98. Excellent clinical outcomes and retention in care for adults with HIV-associated Kaposi sarcoma treated with systemic chemotherapy and integrated antiretroviral therapy in rural Malawi

Author

Herce, Michael E., Kalanga, Noel, Wroe, Emily B., Keck, James W., Chingoli, Felix, Tengatenga, Listern, Gopal, Satish, Phiri, Atupere, Mailosi, Bright, Bazile, Junior, Beste, Jason A., Elmore, Shekinah N., Crocker, Jonathan T., and Rigodon, Jonas

Subjects
Kaposi's sarcoma -- Diagnosis -- Care and treatment, Antiviral agents -- Dosage and administration, Prevalence studies (Epidemiology) -- Methods, Chemotherapy -- Patient outcomes, HIV patients -- Care and treatment, Cancer -- Chemotherapy, Health
Abstract

Introduction: HIV‐associated Kaposi sarcoma (HIV‐KS) is the most common cancer in Malawi. In 2008, the non‐governmental organization, Partners In Health, and the Ministry of Health established the Neno Kaposi Sarcoma Clinic (NKSC) to treat HIV‐KS in rural Neno district. We aimed to evaluate 12‐month clinical outcomes and retention in care for HIV‐KS patients in the NKSC, and to describe our implementation model, which featured protocol‐guided chemotherapy, integrated antiretroviral therapy (ART) and psychosocial support delivered by community health workers. Methods: We conducted a retrospective cohort study using routine clinical data from 114 adult HIV‐KS patients who received ART and ≥1 chemotherapy cycle in the NKSC between March 2008 and February 2012. Results: At enrolment 97% of patients (n/N=103/106) had advanced HIV‐KS (stage T1). Most patients were male (n/N=85/114, 75%) with median age 36 years (interquartile range, IQR: 29–42). Patients started ART a median of 77 days prior to chemotherapy (IQR: 36–252), with 97% (n/N=105/108) receiving nevirapine/lamivudine/stavudine. Following standardized protocols, we treated 20 patients (18%) with first‐line paclitaxel and 94 patients (82%) with bleomycin plus vincristine (BV). Of the 94 BV patients, 24 (26%) failed to respond to BV requiring change to second‐line paclitaxel. A Division of AIDS grade 3/4 adverse event occurred in 29% of patients (n/N=30/102). Neutropenia was the most common grade 3/4 event (n/N=17/102, 17%). Twelve months after chemotherapy initiation, 83% of patients (95% CI: 74–89%) were alive, including 88 (77%) retained in care. Overall survival (OS) at 12 months did not differ by initial chemotherapy regimen (p=0.6). Among patients with T1 disease, low body mass index (BMI) (adjusted hazard ratio, aHR=4.10, 95% CI: 1.06–15.89) and 1 g/dL decrease in baseline haemoglobin (aHR=1.52, 95% CI: 1.03–2.25) were associated with increased death or loss to follow‐up at 12 months. Conclusions: The NKSC model resulted in infrequent adverse events, low loss to follow‐up and excellent OS. Our results suggest it is safe, effective and feasible to provide standard‐of‐care chemotherapy regimens from the developed world, integrated with ART, to treat HIV‐KS in rural Malawi. Baseline BMI and haemoglobin may represent important patient characteristics associated with HIV‐KS survival in rural sub‐Saharan Africa., Introduction Kaposi sarcoma (KS) is a major cause of morbidity and mortality in sub‐Saharan Africa (SSA), resulting in 25,000 deaths each year [1]. In Malawi, KS is the most common [...]

Published
2015
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99. Characteristics and survival for HIV‐associated multicentric Castleman disease in Malawi

Author

Gopal, Satish, Liomba, N George, Montgomery, Nathan D., Moses, Agnes, Kaimila, Bongani, Nyasosela, Richard, Chikasema, Maria, Dhungel, Bal M., Kampani, Coxcilly, Sanders, Marcia K., Krysiak, Robert, Dittmer, Dirk P., and Fedoriw, Yuri

Subjects
Lymphoproliferative disorders -- Statistics -- Patient outcomes, HIV infection -- Statistics -- Complications and side effects -- Patient outcomes, Health
Abstract

Introduction: Clinical reports of multicentric Castleman disease (MCD) from sub‐Saharan Africa (SSA) are scarce despite high prevalence of HIV and Kaposi sarcoma‐associated herpesvirus (KSHV). Our objective is to describe characteristics and survival for HIV‐associated MCD patients in Malawi. To our knowledge, this is the first HIV‐associated MCD case series from the region. Methods: We describe HIV‐positive patients with MCD in Lilongwe, and compare them to HIV‐associated lymph node Kaposi sarcoma (KS) and non‐Hodgkin lymphoma (NHL) patients treated at our centre. All patients were enrolled into a prospective longitudinal cohort study at a national teaching hospital and cancer referral centre serving half of Malawi's 16 million people. We included adult patients≥18 years of age with HIV‐associated MCD (n=6), lymph node KS (n=5) or NHL (n=31) enrolled between 1 June 2013 and 31 January 2015. Results and discussion: MCD patients had a median age of 42.4 years (range 37.2–51.8). All had diffuse lymphadenopathy and five had hepatosplenomegaly. Concurrent KS was present for one MCD patient, and four had performance status ≥3. MCD patients had lower median haemoglobin (6.4 g/dL, range 3.6–9.3) than KS (11.0 g/dL, range 9.1–12.0, p=0.011) or NHL (11.2 g/dL, range 4.5–15.1, p=0.0007). Median serum albumin was also lower for MCD (2.1 g/dL, range 1.7–3.2) than KS (3.7 g/dL, range 3.2–3.9, p=0.013) or NHL (3.4 g/dL, range 1.8–4.8, p=0.003). All six MCD patients were on antiretroviral therapy (ART) with median CD4 count 208 cells/µL (range 108–1146), and all with HIV RNA Conclusions: HIV‐associated MCD occurs in Malawi, is diagnosed late and is associated with high mortality. Improvements in awareness, diagnostic facilities, treatment and supportive care are needed to address this likely under‐recognized public health problem in SSA., Introduction HIV‐associated multicentric Castleman disease (MCD) is a lymphoproliferative disorder caused by Kaposi sarcoma‐associated herpesvirus (KSHV) [1–5]. Unlike Kaposi sarcoma (KS), MCD incidence may be increasing in the antiretroviral therapy [...]

Published
2015
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100. Feasibility of upfront mobile money transfers for transportation reimbursement to promote retention among patients receiving lymphoma treatment in Malawi.

Author

Ellis, Grace K, Manda, Agness, Topazian, Hillary, Stanley, Christopher C, Seguin, Ryan, Minnick, Caroline E, Tewete, Blessings, Mtangwanika, Asekanadziwa, Chawinga, Mena, Chiyoyola, Sara, Chikasema, Maria, Salima, Ande, Kimani, Stephen, Kasonkanji, Edwards, Mithi, Victor, Kaimila, Bongani, Painschab, Matthew S, Gopal, Satish, and Westmoreland, Katherine D

Subjects
TRANSPORTATION of patients, TREATMENT delay (Medicine), REIMBURSEMENT, LYMPHOMAS, TRANSPORTATION costs
Abstract

Background Cancer outcomes in sub-Saharan Africa (SSA) remain suboptimal, in part due to poor patient retention. Many patients travel long distances to receive care, and transportation costs are often prohibitively expensive. These are well-known and established causes of delayed treatment and care abandonment in Malawi and across SSA. Methods We sent visit reminder texts and offered upfront money to cover transportation costs through a mobile money transfer (MMT) platform to lymphoma patients enrolled in a prospective cohort in Malawi. The primary aim was to test the feasibility of upfront MMTs. Results We sent 1034 visit reminder texts to 189 participating patients. Of these texts, 614 (59%) were successfully delivered, with 536 (52%) responses. 320/536 (60%) MMTs were sent to interested patients and 312/320 (98%) came to their appointment on time. Of 189 total patients, 120 (63%) were reached via text and 84 (44%) received MMTs a median of three times (IQR 2–5). Median age of reachable patients was 41 (IQR 30–50), 75 (63%) were male, 62 (52%) were HIV+ and 79 (66%) resided outside of Lilongwe. Conclusion MMTs were a feasible way to cover upfront transportation costs for patients reachable via text, however many of our patients were unreachable. Future studies exploring barriers to care, particularly among unreachable patients, may help improve the efficacy of MMT initiatives and guide retention strategies throughout SSA. [ABSTRACT FROM AUTHOR]

Published
2021
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