Five-Year Survival and Determinants of Diffuse Large B-cell Lymphoma in Resource-Limited Settings: The Impact of HIV/AIDS in a Multi-Center Cohort Study

BackgroundDiffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma and a leading cause of cancer-related mortality worldwide. Evidence on long-term survival and prognostic determinants remains limited, particularly among people living with HIV. This study evaluated survival outcomes and predictors of mortality among adults with DLBCL in Northwest Ethiopia.MethodsWe conducted a multicenter retrospective cohort study of consecutively enrolled adults with newly histologically confirmed DLBCL diagnosed between August 1, 2020, and July 31, 2025, at three referral hospitals in Northwest Ethiopia. Patients were followed from diagnosis until death, loss to follow-up, or study end. Overall survival (OS) was estimated using the Kaplan-Meier method. Cox proportional hazard regression was used to identify independent predictors of mortality. Subgroup analyses were performed depending on HIV status. Statistical significance was set at P ≤0.05.ResultsA total of 175 patients with DLBCL were included, of whom 31 (17.7%) were HIV-positive. The median survival time was 36 months (IQR: 21-49). The estimated 5-year OS was 25%. Advanced disease (stage IV; AHR = 2.7, 95% CI: 1.1-6.5), HIV-positive status (AHR = 2.3, 95% CI: 1.1-5.0), elevated serum lactate dehydrogenase (LDH) (≥2× upper limit of normal; AHR = 2.2, 95% CI: 1.0-4.9), and delayed initiation of chemotherapy (≥2 months; AHR = 2.6, 95% CI: 1.2-5.8) were independently associated with increased mortality. Among HIV-positive patients, neutropenic fever was the sole independent predictor of death (AHR = 4.3, 95% CI: 1.1-17.4).ConclusionsSurvival among patients with DLBCL in Northwest Ethiopia remains poor, particularly among those presenting with advanced disease, those living with HIV, those that have delayed treatment initiation, and those that have elevated serum LDH - all these parameters were independently associated with increased mortality. Strengthening diagnostic capacity, ensuring equitable access to immunochemotherapy, integrating HIV-oncology services, and prioritizing early treatment initiation are essential to improving outcome.