Editorial Comment

The Nigerian Journal of Haematology provides critical articles in adult and paediatric haematology as well as transfusion medicine. The scope of topics of interest for publication is broad and in this current issue we are quite fortunate to see the same reflections with one systematic review, four original articles and one isolated case report on haemoglobin SO-Arab. In this issue, Dosunmu et al  have prepared a state-of-the-art systematic overview of the management modalities of relapsed/refractory follicular lymphoma especially in countries with limited resources and poor settings. The article focuses on critical components such as epidemiology, disease biology, randomized controllled Phase II/III clinical trials, recent treatment guidelines emerging novel targeted therapies including toxicity and drug resistance. This comprehensive review will serve as a quite valuable source for practicing haematologists and medical oncologists who treat non-Hodgkin lymphoma. As it is well known, the success of rituximab has changed the way non-Hodgkin lymphoma is managed today, but still, many patients may not respond and patients who do respond may relapse after a median of approximately one year. There is  still a need for novel therapies in nonHodgkin lymphoma.

Haematological complications are commonly seen in HIV patients including anaemia independent of CD4 counts, neutropenia and thrombocytopenia. Anaemia can be seen more than two thirds of patients with HIV. Potent antiretroviral therapies for HIV infection cause anemia and very low levels of haemoglobin can be observed in those receiving higher doses of zidovudine and progression of clinical disease. Macrocytosis develops during zidovudine therapy without any beneficial effect of vitamin-B12 and folinic acid.  In this issue Aglavdawa et al report effects of combination antiretroviral therapy on haematological variables among people living with HIV in north-eastern Nigeria. This case-control study including 180 patients with appropriate controls, provides insight into the effects of combination antiretroviral therapy on some haematological parameters especially having a positive impact on anaemia compared to treatment naive patients. They did not observe any statistically significant difference in white blood cell counts and platelet counts. This report will be helpful for practicing clinicians in infectious diseases and haematology. Further large scale studies will be needed and the authors should have explained the implications of their observations.

Hodgkin lymphoma (HL) is a lymphoid cancer derived from B cells, composed of ReedSternberg cells surrounded by T- and B-lymphocytes, plasma cells, neutrophils, macrophages and eosinophils. Hodgkin Lymphoma may progress through adjacent lymph nodes, nodal groups and/or to distant sites, which led to the staging system of the disease. Over the years, favorable and unfavorable risk factors were identified by EORTC, ECOG and NCCN (2010) including presence of large mediastinal mass, age over 50 years, more than 4 lymph nodes, erythrocyte sedimentation rate and B symptoms. In this issue, Madu et al aimed to assess prospectively, the relationship between blood counts, histologic subtype and treatment outcomes in 40 patients with HL in Nigeria. They claim that absolute neutrophil count, haemoglobin, elevated serum direct bilirubin and alkaline phosphatase are indicators of disease, which were associated with poor survival. In their series nodular sclerosis was the most common histologic subtype. This prospective small size clinical study has to be improved by recruitment of greater number of patients from each disease stage of HL.

The most important development in the treatment of sickle cell anaemia has been hydroxyurea. Hydroxyurea increases foetal haemoglobin levels and helps to reduce symptoms of severe disease. In this issue, Adebayo et al report their experience with hydroxyurea therapy in a small cohort of 30 patients with sickle cell anaemia (SCA) and its effects on serum levels of thrombospondin-1, soluble L-selectin levels and clinical severity of the disease. Their data show that SCA patients treated with hydroxyurea have lower levels of thrombospondin-1 and L-selectin compared to naive counterparts.

Finally, I am fascinated to read the interesting article by Olarewaju et al reporting the support of MaxCare, Nigeria, in home delivery of tyrosine kinase inhibitors by courier services to a total of 862 patients during the peak COVID-19 pandemic lockdown in Nigeria.

Emin Kansu,
M.D.,FACP Emeritus Professor,
Hacettepe University Cancer Institute,
Ankara-Turkey eminkansu47@gmail.com