Lymphoma: Deadly cancer claiming lives of children in Africa

Daniel Mbugua in hospital in India. Mbugua has been in the country since December receiving treatment not Non Hodgkin's Lymphoma. [Courtesy]

In a region where resources and access to specialised medical care remain limited, Non-Hodgkin’s Lymphoma (NHL), continues to claim the lives of thousands of young patients each year.

As the third most common cancer in children worldwide, this cancer casts a devastating shadow across sub-Saharan Africa.

Leukemia and Lymphoma Society describe Non-Hodgkin’s Lymphoma as a type of cancer that begins in the lymphatic system, which is part of the body’s germ-fighting immune system.

In Non-Hodgkin’s Lymphoma, white blood cells called lymphocytes grow abnormally and can form growths (tumours) throughout the body.

“Non-Hodgkin’s lymphoma is a general category of lymphoma. Many sub-types fall into this category. Diffuse large B-cell lymphoma and follicular lymphoma are among the most common subtypes. The other general category of lymphoma is Hodgkin’s lymphoma,”

According to the World Health Organization, a staggering 15 per cent of all cancers in children under 20 in sub-Saharan Africa are NHL. The disease’s rapid progression and the urgent need for prompt diagnosis and treatment have made it a public health crisis.

“NHL is an extremely aggressive malignancy that requires swift intervention,” warns Dr Doreen Karimi Mutua, a paediatric oncologist at Gertrude’s Children’s Hospital in Nairobi.

“We are talking about a matter of days or weeks between the onset of symptoms and life-threatening complications. Early detection is crucial.”

According to the oncologist, the classification of NHL into precursor and mature cell lymphomas, each with their own distinct characteristics and treatment approaches, adds a layer of complexity to the management of the disease.

Precursor lymphomas, the pediatrician explains, account for around 30 per cent of cases, which tend to present with rapidly growing masses, while mature cell lymphomas can manifest with organ dysfunction, bone marrow involvement, and neurological symptoms.

The St Jude staging system, widely used to assess the extent of the disease, helps guide treatment decisions and risk stratification.

Factors such as age, tumour burden, and the involvement of specific disease sites can have a significant impact on prognosis.

 According to data from the National Library of Medicine, Africa accounts for a disproportionately high number of childhood NHL cases globally, with mortality rates reaching as high as 50-60 per cent in some areas. This is in stark contrast to the 80-90 per cent survival rates seen in high-income countries.

“The disparity is heartbreaking,” says Dr Karimi. “A child’s chance of survival should not be determined by their geographic location. We have to do better.”

Improving outcomes for children with NHL in Africa will require a multi-faceted approach, encompassing better access to diagnostic tools, specialised treatment facilities, and comprehensive supportive care.

WHO has emphasised the need for strengthening healthcare systems, training more pediatric oncologists, and ensuring the availability of essential medicines.

“The challenges are significant, but we cannot afford to be discouraged,” says the oncologist. “With the right resources and a concerted effort, we can make a difference in the lives of these children and their families,” she adds.

She also has some advice to parents navigating this.

“Parents must work closely with their child’s medical team, ask questions, and advocate for the best possible care,” she says, adding, “The treatment process can be overwhelming, but with the right information and support, families can play a crucial role in their child’s recovery.”

As the fight against childhood NHL in sub-Saharan Africa continues, the need for greater awareness, investment, and international collaboration has never been more apparent.