PROF. ABINYA NICHOLAS A O

OBJECTIVE: To evaluate chemotherapy induced myelosuppression, its management and
outcome.
DESIGN: Retrospective analysis of patients aged 13 years and above.
SETTING: Hurlingham Oncology Clinic and the Nairobi Hospital during the period of
June 1998 to June 2003.
SUBJECTS: Two hundred and two solid tumour and lymphoma patients treated with
pulsed chemotherapy at Hurlingham Oncology Clinic and those treated by the same
service at the Nairobi Hospital.
RESULTS: Two hundred patients were evaluable for nadir blood counts. World Health
Organisation (WHO) grade 3 neutropaenia complicated 57 (26.1%), and grade 4
complicated 56 (25.7%) treatments. Grade 0 neutropaenia was seen in 40 (18.4%)
treatments, 33 having included prophylactic Granulocyte-Colony Stimulating
Factors (G-CSF). Neutropaenia was worst following the first and sixth courses,
and repeated second line courses but the difference was not statistically
significant (p = 0.154). Fever complicated 6 grade 3 and 21 grade 4 neutropenic
episodes (23.1% of 117 evaluable). Twenty eight patients were hospitalised
because of severe neutropaenia (23 febrile, and five afebrile initially but with
absolute neutrophil counts < 0.01 x 10(9)/litre). Eight of them died, six
attributable to infections (21.4% mortality) and two attributed to other causes.
Median time to neutrophil recovery to 21.5 x 10(9)/litre was three days with a
mean of 4.6 days. Anaemia and thrombocytopaenia were not commonly experienced.
CONCLUSION: Prophylactic use of G-CSF may have prevented severe neutropaenia and
its use in severe neutropaenia may have reduced the duration and severity of
neutropaenia but the mortality rate for febrile neutropaenia remained high.

OBJECTIVE: To re-evaluate clinico-pathologic categorisation of patients with
Hodgkin's lymphoma, treatments offered and their appropriateness, and outcome of
this disease at Kenyatta National Hospital in the 1990s.
DESIGN: Retrospective survey of Hodgkin's lymphoma patients aged 13 years and
above at the Kenyatta National Hospital.
SETTING: Kenyatta National Hospital, Nairobi, Kenya.
SUBJECTS: Patients aged 13 years and above, with diagnosis of Hodgkin's lymphoma.
RESULTS: There were 75 males and 36 females. One case had no clear gender
details. 14.2% of the cases were of lymphocyte predominant histologic subtype,
23.6% nodular sclerosis, 26.4% mixed cellularity and 17% Lymphocyte depletion
(Rye Modification of Lukes and Butler Classification). Disease stages IIIB, IVA
and IVB (Ann Arbor) were found in 24.5% of the cases. The majority of the
patients (60.3%) were treated with the COPP protocol and 17% with ABVD. Complete
remission was realised in 56% of the cases and most cases were lost to follow-up,
making it difficult to correlate survival with known prognostic parameters, apart
from early stage disease and attainment of complete remission which correlated
with prolonged durations of follow-up.
CONCLUSION: The patients had earlier stage diseases than in earlier studies
locally, the histologic classification is still wanting, and the COPP protocol
appeared still popular instead of being abandoned. Response rates were lower than
expected and losses to follow-up made it difficult to properly evaluate
prognostic parameters. Early disease stage and attainment of complete remission
appeared to correlate with longer follow-up duration.

OBJECTIVES: To determine the clinico-pathologic and prognostic factors, treatment
and outcome of non-Hodgkin's lymphomas as seen at the Kenyatta National Hospital
in the 1990s.
DESIGN: Retrospective study of patients with non-Hodgkin's Iymphoma.
SETTING: Kenyatta National Hospital, Nairobi, Kenya, between January 1990 and
January 2000 inclusive.
SUBJECTS: Patients aged 13 years and above, with non-Hodgkin's Iymphomas.
RESULTS: Case records were available for 207 patients, 146 males and 60 females,
with one having had gender not clarified. Fifty two per cent of the patients were
aged less than 40 years and 18.4% over 60 years. Forty one per cent were not
properly classified histologically, seventy patients out of 190 evaluable (36.8%)
had stages IVA and IVB disease at diagnosis. Twenty five out of 77(32.5%) tested
positive for HIV infection, none of them being of the indolent variety. Up to
57.1% of cases of Burkitt's lymphoma tested positive for HIV infection.
Cyclophosphamide, doxorubicin, vincristine and prednisone, (CHOP) chemotherapy
was given to 68.7% of the patients with complete remission rates of 55.6% for
those who got a minimum of six courses of chemotherapy. Only 15.3% of 105
patients evaluable were followed up for 36 months and above, the majority of
patients having been lost to follow-up. Poor performance status at diagnosis
correlated with shorter follow-up durations (p<0.05).
CONCLUSION: A good percentage of the patients were not comprehensively
characterized pathologically. Standard treatment was offered to the majority of
patients, and those who could afford to purchase the medicines stood good chance
of achieving complete remission. Poor performance status at diagnosis correlated
with shorter follow-up durations and early stage disease correlated with longer
follow-up durations. Overall, the outlook for NHLs treated at KNH in the 1990s
appears to have improved tremendously.

A 17 year old male patient with nodular sclerosis Hodgkin's disease had a relapse of lymphocyte depleted type ten years after entering complete remission with chemotherapy and radiotherapy. This is the first documented case in our experience of relapse after very long disease free interval. A review of the literature of late relapses in Hodgkin's disease is also presented. Relapses have been recorded from three years to twenty years, although few very late forms are registered. Long term follow up will be necessary to document the role of the different therapeutic regimen.

Fifty five sickle cell anaemia (SCA) patients at the Kenyatta National Hospital were studied with a view to elucidating their cardiovascular status. Their age range was 13 to 27 years (median 18.9 years). They comprised 27 males and 28 females and their mean haemoglobin concentration was 8.5 +/- 1.4 g/dl. Haemoglobin level of 8.0-9.9 g/dl seen in 30 patients was noted to confer the lowest incidence of exertional dyspnoea and palpitation. Similarly, patients with this haemoglobin level had the lowest mean heart rate. The mean blood pressure was 114.9 +/- 9.9 mmHg systolic and 64.6 +/- 10 mmHg diastolic. Blood pressures, ejection fraction (EF) and differential fibre shortening (%D) were found to be directly related to haemoglobin level, whereas cardio-thoracic index (CTI) and left ventricular dimensions were inversely related to haemoglobin level. Mean echocardiographic measurements were within normal limits and left ventricular functions were found to be normal in 80.9% of the patients indicating that the majority of SCA patients at the Kenyatta National Hospital have good cardiac function