Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hematol. Feb 6, 2016; 5(1): 37-50
Published online Feb 6, 2016. doi: 10.5315/wjh.v5.i1.37
Retrospective study of a cohort of adult patients with hematological malignancies in a tropical area
Jean-Pierre Droz, Laure Bianco, Béatrice Cenciu, Maïa Forgues, Florin Santa, Jérome Fayette, Pierre Couppié
Jean-Pierre Droz, Cancer and Environment Research Unit, Centre Léon-Bérard, 69008 Lyon, France
Jean-Pierre Droz, Oncoguyane Cancer Network, Cayenne 97300, French Guiana
Jean-Pierre Droz, Jérome Fayette, Department of Medical Oncology, Claude-Bernard-Lyon1 University, 69008 Lyon, France
Jean-Pierre Droz, Jérome Fayette, Department of Medical Oncology, Centre Léon-Bérard, 69008 Lyon, France
Laure Bianco, Béatrice Cenciu, Maïa Forgues, Florin Santa, Jérome Fayette, Pierre Couppié, Department of Amazonian Health, Hospital of Cayenne, Cayenne 97300, French Guiana
Pierre Couppié, French West-Indies and Guiana University, Cayenne site, Cayenne 97300, French Guiana
Author contributions: Droz JP and Bianco L contributed equally to this work; Droz JP, Bianco L and Couppié P designed the study; Droz JP, Cenciu B, Forgues M, Santa F and Fayette J have managed the patients and collected data; Droz JP and Bianco L have analyzed the data; Droz JP and Bianco L have written the manuscript; Cenciu B, Forgues M, Santa F, Fayette J and Couppié P have provided revision of the article for important intellectual content; Droz JP, Bianco L, Cenciu B, Forgues M, Santa F, Fayette J and Couppié P have given final approval of the manuscript.
Institutional review board statement: The entire 594 patient study was the subject of a thesis for an MD degree (Bianco L), and it was reviewed and approved by the University of French Guiana and West Indies Medical School Institutional Review Board.”
Informed consent statement: We did not obtain individual informed consent; we used current hospital medical files; all the data presented were rendered anonymous and the chance of patient identification was extremely low.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jean-Pierre Droz, MD, PhD, Emeritus Professor, Department of Medical Oncology, Centre Léon-Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France.
Telephone: +33-643-178411
Received: July 31, 2015
Peer-review started: August 1, 2015
First decision: November 6, 2015
Revised: December 13, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 6, 2016

AIM: To review the characteristics of hematological malignancies in tropical areas, and to focus on the specific difficulties regarding their management.

METHODS: This is a retrospective narrative review of cases of patients with hematological malignancies. All medical files of patients with malignant disease whose treatment was coordinated by the Hemato-Oncology service of the Cayenne Hospital in French Guiana between the 1st of January 2010 and the 31st of December 2012 were reviewed. Clinical data were extracted from the medical files and included: Demographic data, comorbidities, serological status for human immunodeficiency virus, human T-lymphotropic virus 1 (HTLV1), hepatitis B virus and hepatitis C virus infections, cytology and pathology diagnoses, disease extension, treatment, organization of disease management, and follow-up. The subgroup of patients with hematological malignancies and virus-related malignancies were reviewed. Cases involving patients with Kaposi sarcoma, and information on solid tumor occurrence in virus-infected patients in the whole patient population were included. Since the data were rendered anonymous, no informed consent was obtained from the patients for this retrospective analysis. Data were compiled using EXCEL® software, and the data presentation is descriptive only. The references search was guided by the nature of the data and discussion.

RESULTS: In total, the clinical files of 594 patients (pts) were reviewed. Hematological malignancies were observed in 87 patients, and Kaposi sarcoma in 2 patients. In total, 70 patients had a viral infection, and 34 of these also had hematological malignancies. The hematological diagnoses were: Multiple myeloma in 27 pts, lymphoma (L) in 43 pts, myeloproliferative disorders in 17 pts and Kaposi sarcoma in two patients. The spectrum of non-Hodgkin lymphomas (NHL) was: Burkitt L (1 pt), follicular L (5 pts), chronic lymphocytic leukemia (5 pts), high-grade NHL (9 pts), mucosa-associated lymphoid tissue NHL (4 pts), T-cell lymphoma (4 pts), Adult T-cell lymphoma-leukemia (ATL)/lymphoma/leukemia (12 pts); three patients had Hodgkin disease. The spectrum of myeloproliferative diseases was: Chronic myelogenous leukemia (8 pts), thrombocytemia (5 pts) and acute leukemia (4 pts). There were no polycythemia vera, myelosclerosis, and myelodysplastic diseases. This appears to be due to bias in the recruitment process. The most important observations were: The specificity of HTLV1- related ATL malignancies, and the high incidence of virus infections in patients with hematological malignancies. Further, we noted several limitations regarding the treatment and organization of disease management. These were not related to the health care organization, but were due to a lack of board-certified hemato-oncology specialists, a lack of access to diagnostic tools (e.g., cytogenetic and molecular diagnosis, imaging techniques), the unavailability of radiotherapy, and the physical distance from mainland France. Yet the geography and cultures of the country also contributed to the encountered difficulties. These same limitations are seen in tropical countries with low and intermediate household incomes, but they are amplified by economic, social, and cultural issues. Thus, there is often little access to diagnostic procedures, adequate clinical management, and an unavailability of suitable medical treatments. Programs have been developed to establish centers of excellence, training in pathology diagnosis, and to provide free access to treatment.

CONCLUSION: Management of hematological malignancies in tropical areas requires particular skills regarding specific features of these diseases and in terms of the affected populations, as well as solid public health policies.

Keywords: Tropical hematology, Multiple myeloma, Non-Hodgkin lymphomas, Chronic lymphoid leukemia, Adult T-cell-lymphoma-leukemia, Hodgkin disease, Chronic myeloid leukemia, Acute leukemia, Human T-lymphotropic virus 1, Human immunodeficiency virus

Core tip: Management of hematological malignancies is guided by very specialized and up to date guidelines that are based on the biology of the diseases. An important proportion of these diseases are related to viral infections, and this is particularly so in tropical areas. Based on a narrative review of 87 cases of patients managed in French Guiana, we provide an overview of the most important characteristics of these hematological diseases (e.g., human immunodeficiency virus and human T-lymphotropic virus 1 related diseases), the limitations regarding management (e.g., board-certified specialists, pathology labs, imaging techniques, radiotherapy), and possible solutions to improve quality (e.g., centers of excellence, training programs in pathology). These observations may be more broadly relevant in the setting of countries with low and intermediate household incomes.