Burkitts Lymphoma (BL) is the best-known haematological malignancy (HM) in Africa with its historical importance as a model disease for the role environment factors in neoplastic pathogenesis, (NP) including lifestyles of socioeconomic deprivation (LSSED). BL cell lines, which were created in Africa and make available to international research facilities, provided the opportunity for the discovery of the myc gene, the molecular aberration of which served to identify the role of oncogenes in NP, thereby facilitating the emergence of molecular biology. The exquisite chemosensitivity of BL that enables therapeutic control of BL led to the evolution of the concept of cancer curability. Less well-known is the low incidence of childhood acute lymphoblastic leukaemia (CALL) in Sub-Sahara Africa (SSA), unlike its high incidence among children in the developed countries of Europe and America (DCEA). The frequent association of childhood acute myelogenous leukemia with solid tumours (chloroma) in SSA signifies a role, as in BL, of LSSED in leukemogenesis. Unlike BL, the childhood leukemias (CLs) are less chemo-sensitive in SSA than in DCEA. There is a need to know how lifestyles influence the BL/CLs epidemiology. Similarly, the underlying cause of chemotherapeutic resistance of CALL/CLs in developing versus developed countries, including possible acquired or intrinsic genotypic factors required elucidation. Adult HM, including Hodgkin lymphoma, non-BL non-Hodgkin lymphoma, myeloproliferative disease, myelodysplastic disease and the plasma cell dyscrasia require greater attention. These needs indicate a role for active clinical trial activities, which are the raison d’etre for AORTICHORG.

Burkitts Lymphoma (BL) and childhood acute lymphoblastic leukaemia (CALL) share an inverse relationship in terms of their frequencies in African countries. The low incidence of the leukaemias in Africa is often attributed to “failure of diagnosis,” a view that is supported by observation of under-diagnosis in poorer communities studied in developed countries such as Great Britain. However, evidence has been also been provided that the observation is due to the marked reduction in the incidence of the most common form of childhood leukemia subtype, the “common” acute lymphoblastic leukemia (c-ALL), in developing compared to the developed. The differences in the incidence and clinical manifestations of childhood leukemia/lymphoma between the low-income regions of the Africa and the high-income regions of the world are related to the differences in lifestyles that are prevalent in these varying parts of the world. They indicate the greater role of environmental pressures (EPs) and lifestyles (LSs) on leukemogenesis compared to that of genetic differences of ethnicity and race. Eps/LSs are, probably, related to hygienic factors (HF) and socio-economic factors (SEF), including level of education and income. Eps impact the immune system in ways that have led to natural selection and evolution over billions of years on one hand, and to global and geographical patterns of lympho-proliferative malignant disorders on the other. Given the close association between HF and SEF, there is a need to resolve their differential roles in leukemogenesis.

The human T-lymphotropic virus type 1 (HTLV-1) was the first retrovirus to be associated with human diseases. It shares serological features with HTLV-2. Its epidemiology is global and complex, with the endemic regions including Japan and the less developed countries of Africa, Asia, the Caribbean region, South America and Oceania. The global burden, estimated as 5–10 million, is probably grossly conservative, as vast areas of remain unexplored. It is transmitted mainly by breast-feeding, heterosexual activities, and transfusion of infected blood products. Associated diseases include the neoplastic disease adult T-lymphoma/leukemia (ATL), and infectious complications including infective dermatitis, strongyloidiasis, tuberculosis, leprosy, and Norwegian scabies. Others are inflammatory diseases, including tropical spastic paraparesis (HAM/TSP), arthritis, uveitis and Sjogren syndrome. The diagnosis of these diseases requires specialized laboratory, manpower and technological facilities that are usually unavailable in developing countries. Sporadic cases are therefore usually diagnosed in migrant populations from endemic areas of the developing world in specialized centers in developed countries with specialized facilities. Much of what is known of these diseases come from reports of itinerant scientific and healthcare workers of developed countries with interest in global diseases. The only exceptions are in the endemic areas of Japan, Australia, and Brazil. Public health measures for control of the global burden of the virus, including safe practices of breast-feeding and blood product transfusion, are in place only in a few countries. Addressing challenges of HTLV-1 infection would involve the academia, national governments and regional international institutions of endemic areas in developing countries.

OBJECTIVE The aim of the project is to develop a cost-effective treatment protocol for Acute Lymphoblastic Leukaemia (ALL) with tolerable toxicity and capability for induction of a durable and sustainable complete remission for Nigerian children and young adults up to age 30 years. The General Objective is to evaluate the short- and long-term response of treatment naïve ALL patients to the designed induction, consolidation and maintenance chemotherapeutic regimens.
METHODS The protocol, which is based on the Indian’s highly tested MCP 841 Protocol, as modified (Magrath, et al. Euro J Cancer 2005; 41: 1570-83) shall be presented for discussion. The proposal is multicentred, involving two institutions with competent staff and infrastructure, the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife and the University College Hospital (UCH) Ibadan, respectively. A total of 100 consenting treatment-naïve ALL patients with performance score of ≤ 2 Eastern Oncology Group (ECOG) shall be enrolled. Diagnosis shall be based on peripheral blood (PB) and bone marrow cells morphology, backed by cytochemical and immunophenotypic characterisation of the leukaemic cells, as appropriate. The disease shall be risk-stratified. ALL-L3 (FAB-3) morphology and/or B-ALL (SIg positive) shall be excluded from the study. Tumour cells shall be evaluated for qBCR/ABL fusion gene. All patients shall undergo pre-therapy plain chest radiograph, blood chemistries, HIV/AIDS screening with consent and screening for hepatitis B and hepatitis C viruses. Justification for the huge budget of N 265,445,250.00 shall be defended and challenges for funding shall discussed.
RESULTS Treatment outcome of the limited number of patients that could afford the cost of the regimen shall be discussed.
CONCLUSIONS Financial implication of the trial is very high. Therefore, internal funding agency is highly desirable. The cost is well above the capability of TETFUND, the heaviest national research funder in the country.

OBJECTIVE In spite of the increasing cancer burden, the available cancer specialists remain limited. This has led to the exploration of ways of improving access to quality cancer care within the available resources. Combination chemotherapy requires the consideration of several factors including the tissue diagnosis, immunohistochemistry, clinical stage, the treatment intent, patient clinical status, the preferred regimen and number of cycles, in addition to the functional status of the hematopoietic, hepatic and renal systems. This project aimed to design, implement and evaluate the appropriateness and effectiveness of a spreadsheet-based clinical decision support (CDS) system for cancer chemotherapy, designed for the busy resource-limited clinic setting, and especially those with limited numbers of specialists.
METHODS The current spreadsheet was designed from scratch using MS Excel elements including lists, formulas and VBA macros to automatically calculate relevant intermediate variables, which in turn result in adjustments of chemotherapy drug doses, accounting for patients’ body habitus (body weight or surface area) and the functional state of the bone marrow, liver and kidneys. Adjustments are done in real time to achieve a personalized final regimen, without compromising patient safety and drug efficacy.
RESULTS The spreadsheet was used for training and later piloted among a group of 25 specialists, medical officers and oncology nurses in our chemotherapy clinic in Gaborone. Upon full implementation, the spreadsheet is expected to lead to a more efficient decision-making process, reduced patient waiting times, while ensuring stringent quality control measures.
CONCLUSION We conclude that cancer chemotherapy can be better implemented in busy oncology practices using appropriately designed CDS systems to improved patient care and safety, as well as improve efficiency, especially in settings with human resource constraints.

OBJECTIVE The objective is to share experiences implementing the Novartis Innovative Glivec International Patient Assistance Programme (GIPAP) (now MaxAid/Max Access Solutions since 2017). Since July 2003, the programme provides free life-long Glivec, a novel tyrosine kinase inhibitor, to Nigerians living with Ph/BCR-ABL+ CML.
METHODS Confirmed cases of Ph/BCR-ABL+ CML are registered online with the donor agency and enrolled for the free Glivec supply, irrespective of age, gender, disease stage or prior therapy for the disease. Drugs for Nigeria are shipped periodically to the Obafemi Awolowo University Teaching Hospitals, Ile-Ife from where the medications could only be accessed.
RESULTS From August 2003 to December 2018, 1041 patients have been enrolled comprising 419 (40.2%) and 922 (59.8%) females and males, respectively. The age range of enrolees is from 3 - 87 years with a median of 38 years. The largest majority, 920 (88.4%) were within the age bracket 19 - 60 years. There are 34 (3.3%) paediatric cases aged 18 years and below and 87 (8.4%) older adults aged above 60 years. Enrolees who are intolerant or resistant to Glivec receive newer generations of TKIs like tasigna, bosulif, dasatinib and ponatinib at no cost but only on special request. Two major challenges currently confront the programme: (1) Poor treatment adherence (47%) perhaps because of the financial implications of accessing medication from a single centre in a large country like Nigeria, the cost of follow-up monitoring tests, fear of drug-related infertility, severe adverse effects such as cytopenias and fluid retention necessitating frequent treatment interruption and access to 2nd generation TKIs; and (2) Very small number of enrolees of 1,041 instead of a projected number of 150,000 based on projected annual global incidence of CML of 1/100,000 for a population of 150 million people and at annual growth rate of 2.6%. We believe the small number of enrolees has to do with the financial implications of a single drug collection point for all Nigerian patients irrespective of place of domicile.
CONCLUSIONS The CML targeted therapy programme is a great success, which is highly appreciated by health authorities in the country, such that we were able to obtain a perpetual customs waiver effortlessly since 2005. With decentralisation of treatment centres and assistance with the cost of monitoring tests and ready availability of newer generations of TKIs, many more Nigerians would benefit from the programme.