Long-Term Survival Patterns in Childhood B-Cell Non-Hodgkin Lymphoma in Resource-Constrained Countries

The B cell non-Hodgkin lymphomas (NHL) of childhood and adolescence are among the fifth most common pediatric malignancies worldwide. We conducted a retrospective study and evaluated risk factors influencing long-term survival outcomes in patients with B-cell NHL treated at a tertiary cancer care hospital.

This retrospective descriptive study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center. This study included data of patients diagnosed with B-cell NHL from January 2016 to December 2020, following approval from the institutional review board. Statistical significance was defined as a two-tailed p-value < 0.05. Kaplan-Meier curves were generated in SPSS version 27 (IBM Corporation). Overall survival (OS) was defined as the time from diagnosis to death or last follow-up. Event-free survival (EFS) was defined as the time from diagnosis to death, progression, relapse, treatment abandonment, or last follow-up.

A total of 276 patients with B-cell NHL were registered between January 2016 and December 2020. The median age of the patients was 5 years (IQR: 2). Baseline LDH was strongly associated with mortality, with a greater proportion of deaths occurring among patients with LDH ≥ 2× the upper limit of normal (54.1% vs 19.6%; p<0.01). Advanced stage, tumor lysis syndrome, and poor reassessment response were significantly associated with mortality (p<0.001). In multivariate analysis, patients with TLS had a 2.9-fold higher risk of death compared with those without TLS (2.86; 95% CI: 1.837-4.456; p<0.001). The estimated 5-year overall survival rate was 63.7%, and the event-free survival rate was 62%.

Our study emphasized that the long-term survival outcome of pediatric B-cell NHL in LMIC is significantly inferior in comparison to developed countries due to high disease burden at presentation, along with tumor lysis syndrome, which led to complications such as sepsis. Sepsis was the major cause of death in our population.