Adult Lymphomas in a Tertiary Hospital in South – South Nigeria: A Review of Clinicopathologic Features and Treatment Outcome

Main Article Content

Idongesit Samuel Akpan
Michael Olatunde Tanimowo
Ekemini Ignatius Bassey
Enobong Effiong Uboh
Rosalyn Imo Afia


Background: There has been an increase in the prevalence of Lymphomas in our environment lately. Thorough literature search reveals a limited number of reports on the prevalence of Lymphoma and no information on the clinicopathologic pattern and outcome of treatment of this disease in our centre. Data on the burden of Lymphoma across different regions are important, as there may be variation in incidence in different locations even within the same country. This will keep healthcare providers informed about the current trend of Lymphomas in the region and facilitate prompt and appropriate diagnosis and treatment as well as assist Government agencies in better healthcare planning.

Aim: To determine the burden, clinicopathologic characteristics and treatment outcome of Lymphoma among a cohort of adult patients accessing care in a Referral Hospital in Southern Nigeria

Methods: This was a longitudinal prospective study of all lymphoma cases managed in the Department of Haematology, University of Uyo Teaching Hospital, Uyo, between January 1, 2014 and December 31, 2018

Results: There were 59 cases. Forty 40 (67.8%) were males and 19(32.2%)were females giving a male to female ratio of 4.4:1. Hodgkin Lymphoma(HL) accounted for 11(18.6%) of the cases while Non-Hodgkin Lymphoma(NHL) accounted for 48( 81.4%)of the cases , with the mean ages for HL and NHL patients being 32.09 +9.22 years and 40.88 + 12.21 years, respectively. The distribution of the different histologic subtypes of the malignancy were as follows: HL; Nodular Lymphocyte Predominant(7cases;63.6%), Nodular Sclerosis(2 cases;18.2%) and Lymphocyte Depleted(2 cases;18.2%). NHL; Small Lymphocytic Lymphoma(23cases;47.9%),Diffuse Large Cell Lymphoma(15 cases;31.3%),unspecified

(4 cases;8.3%), Follicular Lymphoma(2 cases;4.2%),Lymphoblastic Lymphoma(2 cases;4.2%), Mantle Cell Lymphoma(1 case;2.1%) and Adult T-Cell Lymphoma(1 case;2.1%). Fourteen 14 (29.2%) out of all the NHL patients had immunohistochemistry and only nine 9 of them were CD20 positive. Relapse rate among the cohort was 11.9% (7/59), while 15.3% (9/59) were still in remission. The cure rate was 5.1%, loss to follow up was 22.0% and 37.3% of patients died in the course of therapy either from advanced disease, non -compliance to treatment or late presentation. All the HL patients received ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine) regimen alone. Majority of the NHL patients (91.7%, 44/48) received CHOP (Cyclophosphamide, Doxorubicin, Oncovin and Prednisolone) regimen alone, while 8.3% (4/48) received Rituximab with CHOP (R-CHOP).

Conclusion: The clinicopathological profile, age and sex distribution of lymphoma in our study were comparable to those reported by other authors with nodular lymphocyte predominant being the most common HL histologic subtype and small lymphocytic lymphoma the predominant NHL histologic subtype in our environment. The general outcome was very poor with a high default rate and unsettling mortality figures.

Hodgkin lymphoma, non-hodgkin lymphoma, ABVD, CHOP, rituximab, Nigeria.

Article Details

How to Cite
Akpan, I. S., Tanimowo, M. O., Bassey, E. I., Uboh, E. E., & Afia, R. I. (2021). Adult Lymphomas in a Tertiary Hospital in South – South Nigeria: A Review of Clinicopathologic Features and Treatment Outcome. International Blood Research & Reviews, 12(1), 28-40.
Original Research Article


Swerdlow SH, Harris NL, Jaffe ES, et al. Tumours of hematopoietic and lymphoid tissues. Lyon: IARC Press; 2008.

Sathiya M, Muthuchelian K. Significance of immunological markers in the diagnosis of lymphomas. Acad J. Cancer Res. 2009;2(1):40-50.

Omoti CE, Halim NKO. Adult malignant lymphomas in University of Benin Teaching Hospital, Benin City, Nigeria, incidence and survial. Nig J Clin Pract. 2007;10(1):10-14.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T. Cancer statistics, 2008. CA: A Cancer Journal for Clinicians. 2008;58:71-96.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7-30.

Miranda–Filho A, Pineros M, Znaor A, Bray F, Marcos–Gragera R, et al. Global patterns and trends in the incidence of non-hodgkin lymphoma. Cancer Causes and control. 2019;30:489-499.

Ferlay J, Ervik M, Dikshit R, Eser S, Mathers C, et al. Globocan 2012 v 1.0. Cancer Incidence and Mortality Worldwide IARC; 2014.

Nair R, Arora N, Mallath MK. Epidemiology of non-hodgkin’s lymphoma in India. Oncology. 2016;91(1):18-25.

World Health Organization. World Cancer Factsheet (

Macharia LW, Mureithi MW, Anzala O. Cancer in Kenya: Types and infection – attributable. Data from the adult population of two National referral hospitals (2008 – 2012). AAS Open Research. 2019;25:1-39.

Yusuf I, Atanda AT, Umar AB, Imam MI, Mohammed AZ, et al. Cancer in Kano, Northwestern Nigeria: A 10-year update of the Kano cancer registry. Annals of Tropical Pathology. 2017;8(2):87-93.

Gopal S, Wood WA, Lee SJ. Meeting the challenge of hematologic malignancies in sub-Saharan Africa. Blood. 2012;119(22):5078-87.

Mondal SK, Mandal PK, Samanta TK, Chakaborty S, Roy SD, et al. Malignant lymphoma in Eastern India: A retrospective analysis of 455 cases according to World Health Organization classification. Indian J Med Paediar Oncol. 2013;34(4):242-246.

Rogena EA, De Falco G, Schurfeld K. A review of the trends of lymphomas in the equatorial belt of Africa. Hematol Oncol. 2011;29(3):111-5.

Eldeek BS, Alahmadi JR, Alattas M, Sait K. Knowledge, perception, and attitudes about cancer and its treatment. Among Healthy Relatives of Cancer Patients: Single Institution Hospital – Based Study in Saudi Arabia. Journal of Cancer Education. 2014;29(4).
DOI:10.10071S 13187-014-0653-7

BOFFETA PI. Epidemiology of adult non-Hodgkin lymphoma. Ann Oncol. 2011;22(4):27-31.

Sara H, Jennifer MP. Temporal trends in incidence of primary brain tumours in the United States, 1985-1999. Neuro Oncol. 2006;32(8):27-37.

Project TIN-HLPF. A predictive model for aggressive non-hodgkin’s lymphoma. N Engl J Med. 1993;329(14):987-94.

Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: A report from the Haematological Malignancy Research Network. Br J Cancer. 2011;105(11):1684 – 92.

Laurini JA, Perry AM, Boilesen E, Diebold J, Maclennan KA, et al. classification of non-hodgkin lumphoma in central and South America. A review of 1028 cases. Blood 2012;120:4795–4801.

Perry AM, Diebold J, Nathwani BN, Maclennan KA, Muller-Hermelink HK, et al. Relative frequency of non-hodgkin lymphoma subtypes in selected centres in North Africa, the middle East and India: A review of 971 cases. Br J Haematol. 2016;172:699-708.

Mozaheb Z, Aledavood A, Farzad F. Distributions of major subtypes of lymphoid malignancies among adults in Mashhad, Iran. Cancer Epidemiol. 2011;35:26-29.

Lee MY, Tan TD, Feng AC, Liu MC. Clinicopathological analysis of malignant lymphoma in Taiwan, defined according to the World Health Organization Classification. Haematologica. 2005;90: 1703-1705.

Roman E, Smith AG. Epidemiology of lymphomas. Histopathology. 2011;58:4-14.

Mani H, Jaffe ES. Hodgkin lymphoma: An update on its biology with new insights into classification. Clin Lymphoma Myeloma. 2009;9:206-216.

Cartwright RA, Gurney KA, Moorman AV. Sex ratios and the risks of hematological malignancies. Br J haematol. 2002;118: 1071-7.

Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic factors Project on Advanced Hodgkin’s disease. N Engl J med. 1998;339:1506-14.

Ariad S, Lipshitz I, Benharroch D, Gopas J, Barchana M. A sharp rise in the incidence of hodgkin’s lymphoma in young adults in Israel. Isr Med Assoc J. 2009;11:453-5.

Caporaso NE, Goldin LR, Anderson WF, Landgren O. Current insight on trends, causes and mechanisms of Hodgkin’s lymphoma. Cancer J. 2009;25:117-23.

Cleary SF, Link MP, Donaldson SS. Hodgkin’s disease in the very young. Int. J Radiat Oncol Biol Phys. 1994;28:77-83.

Stewart SL, King JB, Thompson TD, Friedman C, Wingo PA. Cancer-mortality surveillance – United States 1990-2000. MMWR Surveill Summ. 2004;53:1-108.

Cartwright RA, Watkins G. Epidemiology of hodgkin’s disease: A review. Hematol Oncol. 2004;22:11-26.

Horning SJ. Hodgkin’s lymphoma. In: Lichtman MA, Kipps TJ, Kaushansky K, Beutler E, Prchal JT. Williams Hematology. New York: McGraw Hill. 2006;1461-82.

Ajetunmobi OI, Mandong BM, Adelusola KA, Silas OA. Immunohistochemical profiling of lymphomas in Jos University Teaching Hospital. Jos. International Journal of Health Sciences and Research. 2018;2(8):7-18.

Akinbami A, Dada MO, Balogun M. Adult haematooncology cases: A six year review at Lagos State University Teaching Hospital Ikeja. The Internet Journal of Dental Science. 2009;(61):8-14.

Ugboko VI, Oginni FO, Adelusola KA, Durosinmi MA. Orofacial non-hodgkin’s lymphoma in Nigerians. J oral Maxillofac. Surg. 2004;62(11):1347-50.

Dei-Adomakoh YA, Asare EV, Amedonu ESA, Abrahams ED, Segbefia CI, Acquaye JK. Sub-types and treatment outcomes of adolescent and adult non-hodgkin lymphomas in a resource poor setting. Journal of Hematology and oncology Research. 2017;3:15-21.

Shen Y, Zhang R, Liu L, Shen Y, Song W, Qi T, et al. Clinical and prognostic analysis of 78 patients with human immuno-deficiency virus associated non-Hodgkin’s lymphoma in Chinese population. Infect Agent Cancer. 2017;12(1):7.

Thieblemont C, Coiffier B. Lymphoma in older patients. journal of Clinical Oncology 2016;14:1-8.

Grossoeuvre A, Thieblemont C, Houot R, Salles G, Coiffier B. Non-hodgkin’s lymphoma in very elderly patients over 80 years. A descriptive analysis of clinical presentation and outcome. Ann Oncol. 2008;19(4):774-9.

Iliyasu Y, Zhao W, Ayesi LW. Malignant lymphoma subgroups from Zaria. Infect Agent Cancer. 2010;5(1):1750-9378.

Mwankigonja AR, Kaaya EE, Mgaya ME. Malignant lymphomas and HIV infection in Tanzania. J Exp Clin Cancer Res. 2008;27(9):1756-1766.

Chai SP, Peh SC, Kim LH, Lim MY, Gudum HR. The pattern of lymphomas in East Malaysian patients as experienced in the University Hospital, Kuala Lumpur. Malaysian J Pathol. 1999;21(1):45-50.

Yakubu M, Ahmadu BU, Yerima TS, Simon P. Hezekiah IA, Pwavimbo AJ. Prevalence and clinical manifestation of lymphomas in North Eastern Nigeria. Indian J. Cancer. 2015;52:551-5.

Kolawole H. The clinicopathologic features of hodgkin lymphoma in Lagos, Nigeria: An update on biology and histopathology diagnosis. American Journal of Clinical Pathology. 2018;150:102-103.

Caminha BL, Viera GH, Pimenta MB, Tavares NA, Albuquerque TM, et al. Epidemiological analysis of lymphoma subtypes in a reference center in Joao Pessoa, Paraiba, Brazil. International Journal of Physical Medicine and Rehabilitation. 2018;6:1-8.

Okpala IE, Akang EE, Okpala UJ. Lymphomas in University College Hospital, Ibadan, Nigeria. Cancer. 1991;68:1356-62.

Olu-Eddo AN, Omoti CE. Hodgkin lymphoma: Clinicopathologic features in Benin City, Nigeria and update on its biology and classification. Nigerian Journal of clinical practice. 2011;14:440-444.

Al-Mudallal SS, Al-Sinjery GM. Immunohistochemical expression of epstein barr virus antigen latent membrane protein – 1 and BCL – 2 in Classical Hodgkin Lymphoma. Iraqi J Med Sci. 2012;10(3):234-242.

Engel M, Essop MF, Close P, Hartleg P, Pallesen G, Sinclair-Smith C. Improved prognosis of epstein-barr virus associated childhood hodgkin lymphoma: Study of 47 South African cases. J clin Pathol. 2000;53:182–186.

Ochicha O, Edino ST, Mohammed AZ, Umar AB, Atanda AT. Pathology of peripheral lymph node biopsies in Kano, Northern Nigeria. Ann Afr Med. 2007;6(3):104-108.

Walter PR, Klotz F, Alfy Gattas T, Miniko D, Nguembi C. Malignant lymphomas in gabon equatorial Africa, a morphologic study of 72 cases. Human Pathology. 1991;22(10):1040-1043.

Onwubuya MI, Adelusola KA, Durosinmi M, Sabageh D. Lymphomas in Ile-Ife, Nigeria: Immunohistochemical characterization and detection of epstein – barr virus encoded RNA. Journal of Clinical and Diagnostic Research. 2015;9(6):14-19.

Miura Y, Fukuhara N, Yamamoto J, Kohata K, Ishizawa K, Harigae H. Clinicopathological features of malignant lymphoma in Japan: The miyagi study. Tohoku J Exp Med. 2011;224(2):151-60.

Isokogodan A, Ayyildiz O, Buyukcelik A, Arslan A, Tiftick N, Buyukbayram H, et al. Non-hodgkin lymphoma in Southeast Turkey. Annals of Hematology. 2004;83(5):265-269.

Madu AJ, Korubo K, Ajuba IC, Ugwu NI, Okoye AE, Ugwu AO, et al. Non-hodgkin lymphoma in Nigeria: An insight into the clinical, laboratory features and outcomes. Asian Hematology Research Journal. 2020;3(3):13-22.

Oluwasola AO, Olaniyi JA, Otegbayo JA, Ogun GO, Akingbola TS, et al. A fifteen-year review of lymphomas in a Nigerian Tertiary Healthcare Center. 2011;29(4):310-316.

Cool CD, Bittery MA. The malignant lymphomas of Kenya. Morphology, Immunophenotype, and Frequency of Epstein-Barr virus in 73cases. Hum Pathol. 1997;28(9):1026-33.

Obafunwa JO, Akinsete I. Malignant lymphomas in Jos, Nigeria. Centr Afr J Med. 1992;38(1):17-25.

Adelusola KA, Adeniji KA, Somotun GO. Lymphoma in adult Nigerians. West Afr J Med. 2011;20(2):123-6.

Tamseela M, Nabila R, Waheed MA. Incidence and clinical manifestation of lymphoma in central Punjab. Pak J 2001. 2012;44:1367-72.

Omotayo JA, Duduyemi DM, Buhari MO, Anjorin AS. Histopathological pattern of childhood solid tumours in Ilorin: A 28-yr retrospective review. Am J Med Sc. 2013;1(6):105-109.

Okpe ES, Abok II, Ocheke IE, Okolo SN. Pattern of childhood malignancies in Jos, North Central Nigeria. Jour of Med in the tropics. 2011;13(2):109-114.

Williams AO. Tumours of childhood in Ibadan, Nigeria. Cancer. 1975;36(3):70-78.

Ngim NE, Nottidge T, Oku A, Akpan AF. Why do trauma patients leave against medical advice. Ibom Med Jour. 2013;6(1):1-4.

Pierpont TM, Limper CB, Richards KL. Past, present, and future of rituximab – The world’s first oncology monoclonal antibody therapy. Front. Oncol. 2018;8:163–172.

Andre ME, Carde P, Viviani S, Bellei M, Fortpied C, et al. Long – term overall survival and toxicities of ABVD vs BEACOPP in advanced hodgkin Lymphoma: A pooled analysis of four randomized trials. Cancer Medicine. 2020;18:6565–6575.

Massoud M, Kerbage F, Nehme J, Sakr R, Rached L, et al. Survival pattern of hodgkin lymphoma patients in the Last 25 years in Lebanon. Clinical Lymphoma, Myeloma and Leukemia. 2017;17:588-591.

Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, et al. The revised international prognostic index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. 2007;109:1857–61.

Muneishi M, Nakamura A, Tachibana K, Suemitsu J, Hasebe S, Takeuchi, et al. Retrospective analysis of first line treatment for follicular lymphoma based on outcomes and medical economics. Int J Clin Oncol. 2018;23(2):375–81.