About the study
Non-communicable diseases in Sub-Saharan Africa (SSA) constitute a major public health challenge. The disease burden attributable to cancer is rapidly rising, with a predicted 85% increase in incidence by 2030. In a region where 40% of the entire population is under the age of 15, cancer is more likely to present in younger patients in sub-Saharan Africa, as demonstrated by rising numbers of paediatric or adolescent patients. Aggressive lymphoma accounts for almost 10% of all cancer diagnosis in the region, due to a strong association with Epstein Barr virus (EBV) infection. Diagnosing these lymphomas using tissue samples poses a significant challenge in SSA, as a single pathologist may be responsible for up to 3.2m patients within a given region. It can also be difficult to obtain tumour tissue samples from young children. Therefore, despite tissue biopsy remaining as the gold standard diagnostic test, a major hurdle to diagnosis is obtaining a result in a timely manner. Samples are often transported overseas for reporting in large established tertiary labs.
With the availability of digital pathology and low-cost blood DNA analysis, we have the potential to quickly and accurately screen, diagnose and monitor children and young adults with EBV-associated lymphoma (EBVL), without needing to take a tissue sample. A liquid biopsy test only requires an additional 4-10ml (1-3 teaspoons) of blood collected into a specialised blood tube. Given that all patients currently have standard of care (SOC) testing, including routine blood tests, this additional sample poses minimal if any risk to the patient.
Our project, Aggressive Infection-Related East African Lymphomas (AI-REAL), is a collaboration between clinical and academic institutions in Tanzania (Muhimbili National Hospital, Kilimanjaro Christian Medical Centre, Muhimbili University of Health and Allied Sciences), Uganda (St Mary’s Hospital, Lacor) and the UK (University of Oxford) that aims to assess the accuracy of two low cost novel technologies (for diagnosing EBVL in East African patients aged 3 to 30 suspected of having the condition:
- Liquid biopsy – The detection of fragments of lymphoma-specific DNA shed into the bloodstream from tumours. This test requires the collection of 10ml (2 teaspoons) of blood. We already have early data from an Oxford University study of lymphoma patients that shows a high sensitivity and specificity for ctDNA as a diagnostic tool.
- Mobile digital microscopy – A device that can reproduce high-resolution, diagnostic quality, whole slide digital images from blood smears and tissue biopsy slides to be assessed by pathologists remotely.
We will therefore assess the utility of a digital microscopy platform which we are already using for teaching and training in the region. This technology will enable local scientists of obtain diagnostic quality digital images of traditional histopathology glass slides that can be shared immediately for reporting.
Professor Anna Schuh
MD, PhD, FRCP, FRCPath, Honorary Consultant Haematologist, University of Oxford, UK
Dr Elifuraha W Mkwizu
Dr Mkwizu received medical education and training from a number of institutions. A medical degree (MD) from Nizhny Novgorod State Medical Academy, Russian Federation. Master`s degree in Internal Medicine (Mmed) from Kilimanjaro Christian Medical University College, Moshi Tanzania, EA Diploma in Tropical Medicine and Hygiene, London School of Tropical Medicine &Hygiene (LSTMH) and a Post Graduate Fellowship in Clinical Haematology and Bone Marrow Transplantation from TATA Medical Centre, Kolkata India.
Dr. med. Oliver Henke
Dr Oliver Henke is a Haematologist & Medical Oncologist from Germany and works at Kilimanjaro Christian Medical Centre since 2016. Together with Dr. Elifuraha Mkwizu he has established haematological services including modern diagnostics and therapies for patients from Northern Tanzania. Dr. Henke mentors this research project for Oxford university at KCMC site.
Dr Clara Chamba
MD, MMed, PhD Cand
Dr Clara Chamba, a medical specialist in haematology and blood transfusion, is the Muhimbili University of Health and Allied Sciences (MUHAS) site Principal Investigator for the AI-REAL project. She is a lecturer and coordinator of the postgraduate training programme in the department of Haematology and Blood Transfusion in MUHAS.
Dr Sam M Mbulaiteye
MBChB, MPhil, MMed
Dr. Mbulaiteye is a senior investigator (see here) in the Infections and Immunoepidemiology Branch (IIB) in the Division of Cancer Epidemiology and Genetics (DCEG) at the US National Cancer Institute (NCI). He conducts multidisciplinary epidemiological research to understand the role of infections, immunity, and genetic factors in the aetiology of cancer, particularly Burkitt lymphoma and Kaposi sarcoma.
Dr Hadija Mwamtemi
MD, MMED, PhD PaedHaem/Onco
Dr. Hadija Mwamtemi is a senior medical specialist at Muhimbili National Hospital in the department of Paediatrics and Child Health. She obtained her MD degree (1988) In the University of Havana Cuba Calxito (Garcia Hospital). In 1993 she was enrolled in master’s programme of Paediatrics in Muhimbili University Collage of Health sciences, in 1995 she secured Monmbusho scholarship by the Government of Japan. She completed course work in Paediatrics and was enrolled in PhD programme in the University of Shinshu Medical School
Sam M. Mbulaiteye
MBChB, MPhil, MMed.
Dr. Mbulaiteye is a senior investigator (see here) in the Infections and Immunoepidemiology Branch (IIB) in the Division of Cancer Epidemiology and Genetics (DCEG) at the US National Cancer Institute (NCI). He conducts multidisciplinary epidemiological research to understand the role of infections, immunity, and genetic factors in the etiology of cancer, particularly Burkitt lymphoma and Kaposi sarcoma.
To achieve these goals, Dr. Mbulaiteye designed and conducted a large multi-country, multiyear case-control study of endemic Burkitt lymphoma called Epidemiology of Burkitt Lymphoma in East-African Children and Minors (EMBLEM) study (https://emblem.cancer.gov/) in six rural regions in Uganda, Tanzania, and Kenya between 2010-2016. EMBLEM collected well annotated samples to facilitate research for the discovery of biomarkers that may be used for earle detection, diagnosis, prognosis, or prevention of Burkitt lymphoma.
In addition, Dr. Mbulaiteye has established collaboration with the AI-REAL study as an investigator, a member of the Steering Committee, and as a mentor. He has provided full access to his collaborators at St. Mary’s Hospital Lacor in Uganda to the AI-REAL study and allowed full collaborative access to the EMBLEM facilities in Uganda.
The Aggresive Infection Related East Africa Lymphoma
Ensuring all patients have the opportunity to take part in our research.