Amaeshi Lemchukwu C, Adelabu Yusuf, Kalejaiye Olufunto
Montefiore Medical Center, Bronx, NY 10467, USA.
College of Medicine University of Lagos, Lagos, Nigeria.
Ecancermedicalscience. 2025 Apr 23;19:1896. doi: 10.3332/ecancer.2025.1896. eCollection 2025.
Haematological malignancies (HMs) account for approximately 10% of all malignancies in sub-Saharan Africa (SSA), and their incidence is rapidly increasing. Successful management of these malignancies depends on early presentation, diagnosis and prompt initiation of treatment. However, in SSA and many low and middle-income countries, several barriers hinder the effective management of these malignancies. This case report of a patient with acute promyelocytic anaemia highlights the challenges in managing HM.
A 31-year-old woman presented to a primary health care centre with recurrent rectal bleeding and was diagnosed with haemorrhoids. She was given iron and was reassured of her symptoms. However, when her symptoms persisted, she was referred to an academic medical centre for definitive management of her haemorrhoids. On further evaluation, she was diagnosed with acute promyelocytic anaemia based on morphologic findings, as further morphological and molecular analysis could not be done due to the non-availability of advanced diagnostic infrastructure locally. Treatment initiation with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) was delayed due to the unavailability of the medication locally and, therefore, had to be ordered from a different country. During this time, she developed febrile neutropenia and sepsis, and her care was limited by the unavailability of blood products and the unaffordability for necessary supportive medications. Eventually, she could only start ATRA as she could not afford ATO. As a result, she could not complete the entire course of treatment. Despite this, she showed clinical improvement and some haematological recovery and was discharged but, unfortunately, was lost to follow-up in the outpatient setting.
Several barriers exist in managing HM and other cancers in general in SSA. Overcoming these barriers and improving outcomes in HM requires capacity building, international collaboration and political engagement.
血液系统恶性肿瘤（HMs）约占撒哈拉以南非洲（SSA）所有恶性肿瘤的10%，且其发病率正在迅速上升。这些恶性肿瘤的成功管理取决于早期就诊、诊断和及时开始治疗。然而，在撒哈拉以南非洲以及许多低收入和中等收入国家，有几个障碍阻碍了这些恶性肿瘤的有效管理。本例急性早幼粒细胞贫血患者的病例报告突出了血液系统恶性肿瘤管理中的挑战。
一名31岁女性因反复直肠出血就诊于一家初级医疗保健中心，被诊断为痔疮。她接受了铁剂治疗，并被告知其症状会缓解。然而，当她的症状持续存在时，她被转诊至一家学术医疗中心以对其痔疮进行明确治疗。进一步评估后，根据形态学检查结果她被诊断为急性早幼粒细胞贫血，由于当地缺乏先进的诊断基础设施，无法进行进一步的形态学和分子分析。由于当地无法获得全反式维甲酸（ATRA）和三氧化二砷（ATO），开始治疗的时间被推迟，因此不得不从另一个国家订购。在此期间，她出现了发热性中性粒细胞减少和败血症，由于无法获得血液制品以及无力承担必要的支持性药物，她的治疗受到限制。最终，由于她负担不起ATO，只能开始使用ATRA。结果，她无法完成整个疗程。尽管如此，她仍有临床改善和一些血液学恢复，并出院了，但不幸的是，她在门诊随访中失访。
在撒哈拉以南非洲，管理血液系统恶性肿瘤和其他癌症总体上存在若干障碍。克服这些障碍并改善血液系统恶性肿瘤的治疗效果需要能力建设、国际合作和政治参与。
