This is an application for a Fogarty International Center K01 International Research Scientist Development Award for Dr. Satish Gopal, an infectious disease physician and medical oncologist at the University of North Carolina at Chapel Hill. Dr. Gopal is establishing himself as a young investigator in the areas of HIV-associated lymphoma and lymphoma treatment in resource-limited settings. This K01 award will provide Dr. Gopal with the support necessary to accomplish the following goals: (1) to become an expert in clinical trial conduct in resource-limited settings;(2) to develop skills in multidisciplinary, long-distance collaboration;(3) to gain additional experience in advanced study design and biostatistical methods;and (4) to learn fundamentals of health-related quality of life research. To achieve these goals, Dr. Gopal has assembled a mentoring team comprised of a US primary mentor, Dr. Thomas Shea, Interim Chief of the Division of Hematology and Oncology, an international leader in collaborative clinical trials in hematologic malignancies, and a Malawi primary mentor, Dr. Mina Hosseinipour, Clinical Director of UNC Project-Malawi and an expert in clinical trials in sub-Saharan Africa, as well as three co-mentors;Drs. Blossom Damania and Dirk Dittmer, experts in pathogenic mechanisms of viral oncogenesis with particular interest in HIV malignancies;and Dr. William Miller, an expert in analytic methods and mentoring young investigators toward research independence. Lymphoma is one of the most common cancers in sub-Saharan Africa with rapidly increasing incidence. Dr. Gopal's research will focus on accurate histopathologic diagnosis among patients with suspected lymphoma in Malawi (Aim 1), systematic collection of clinical and laboratory data among patients with suspected lymphoma (Aim 2), and longitudinal follow-up among those with confirmed hematologic malignancies receiving treatment under local conditions (Aim 3).
In Aim 1, Dr. Gopal will perform core lymph node biopsies on at least 200 consecutively enrolled patients with suspected lymphoma.
In Aim 2, Dr. Gopal will collect relevant clinical and laboratory data among patients at the time of enrollment and lymph node biopsy, and correlate these data with final histopathologic diagnosis.
In Aim 3, Dr. Gopal will perform systematic, longitudinal assessments for 2 years among those with confirmed hematologic malignancies to evaluate response to therapy, treatment-related toxicities, costs of treatment, and health-related quality o life (HRQOL) measures. The studies outlined in this proposal will form the basis for a multicenter clinical trial of lymphoma treatment in sub-Saharan Africa to be proposed in an R01 application before the end of the career development award period.

Public Health Relevance

The burden of lymphoma is rapidly increasing in sub-Saharan Africa, and current diagnostic and treatment strategies are inadequate. Improved understanding of the clinical and histopathologic features of lymphoma is critical to developing effective treatments which are feasible under local conditions in resource- limited settings.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Scientist Development Award - Research & Training (K01)
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International and Cooperative Projects - 1 Study Section (ICP1)
Program Officer
Jessup, Christine
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University of North Carolina Chapel Hill
Internal Medicine/Medicine
Schools of Medicine
Chapel Hill
United States
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Kohler, Racquel E; Tang, Jennifer; Gopal, Satish et al. (2016) High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi. Int J STD AIDS 27:753-60
Heimlich, J Brett; Chipoka, Godwin; Kamthunzi, Portia et al. (2016) Establishing sickle cell diagnostics and characterizing a paediatric sickle cell disease cohort in Malawi. Br J Haematol 174:325-9
Gutnik, Lily; Moses, Agnes; Stanley, Christopher et al. (2016) From Community Laywomen to Breast Health Workers: A Pilot Training Model to Implement Clinical Breast Exam Screening in Malawi. PLoS One 11:e0151389
Gutnik, Lily; Lee, Clara; Msosa, Vanessa et al. (2016) Clinical breast examination screening by trained laywomen in Malawi integrated with other health services. J Surg Res 204:61-7
Montgomery, Nathan D; Liomba, N George; Kampani, Coxcilly et al. (2016) Accurate Real-Time Diagnosis of Lymphoproliferative Disorders in Malawi Through Clinicopathologic Teleconferences:  A Model for Pathology Services in Sub-Saharan Africa. Am J Clin Pathol 146:423-30
Gopal, Satish; Fedoriw, Yuri; Kaimila, Bongani et al. (2016) CHOP Chemotherapy for Aggressive Non-Hodgkin Lymphoma with and without HIV in the Antiretroviral Therapy Era in Malawi. PLoS One 11:e0150445
Gopal, Satish (2016) Moonshot to Malawi. N Engl J Med 374:1604-5
Stanley, Christopher C; Westmoreland, Kate D; Heimlich, Brett J et al. (2016) Outcomes for paediatric Burkitt lymphoma treated with anthracycline-based therapy in Malawi. Br J Haematol 173:705-12
Kohler, Racquel E; Lee, Clara N; Gopal, Satish et al. (2015) Developing a discrete choice experiment in Malawi: eliciting preferences for breast cancer early detection services. Patient Prefer Adherence 9:1459-72
Montgomery, Nathan D; Graham, Tiffany; Krysiak, Robert et al. (2015) Comparison of eosinophil density in staging bone marrow biopsies from Malawi and the United States. Pathol Int 65:671-3

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