Challenges associated with the Management of Haematological Malignancies in sub-Saharan Africa

Abstract

Haematological cancers or malignancies (leukaemia, lymphoma and myeloma) are a group of disorders that affect the production and function of blood cells. The aim of this review was to highlight the major challenges affecting the effective management of haematological malignancies particularly in sub-Saharan Africa (SSA). PubMed, Google Scholar, Science Direct and African Journals Online search was performed in January 2020 and studies on best practices on the diagnosis and management of haematological malignancies were sought. Search keywords included “haematological malignancies, management and evidenced-based global best practices”. In most SSA countries, advanced health care systems and technologies required for the effective management of patients are neither geographically nor economically accessible. There is poor access to chemotherapeutic agents and radiotherapy services due to socioeconomic realities. Modern diagnostic equipment and techniques (Immunophenotyping, Fluorescent In situ Hybridization, Cytochemical Stains and Polymerase Chain Reaction and Apheresis) required for the diagnosis and management are often unavailable. There is suboptimal access to safe and adequate supply of blood and components (fresh frozen plasma, cryoprecipitate, platelet concentrate, HLA and HPA matched platelets, irradiated, CMV negative and antigen negative blood products) required for the effective transfusion support of these patients. Capacity to carry out bone marrow and haemopoietic stem cell transplant is often unavailable. There is poor health infrastructure, inadequacy of qualified staff (laboratory scientists, pathologists and oncologists) and suboptimal financial resources to support the running of effective haemato-oncology service. There is need for the establishment of a collaborative network among professionals responsible for the diagnosis and management of haematological malignancies. Pharmaceutical companies need to be humane by ensuring the availability, affordability and accessibility to life saving chemotherapeutics, radiotherapy and iron chelation agents. There is need to optimize health infrastructure both human (personnel) and material (equipment, reagent, consumables and physical) to facilitate the optimum management of haematological cancers in SSA.