Treatment Outcome and Predictors of Pediatric Non-Hodgkin Lymphoma in Ethiopia

Abstract

Background: Significant improvement in pediatric Non-Hodgkin Lymphoma (NHL) treatment outcomes has been achieved in high-income countries. In contrast, outcomes in resource limited settings remain variable and generally poor. These disparities are largely attributed to differences in early diagnosis, access to advanced supportive care, and the availability of intensive chemotherapy regimens in developed countries compared to those in low- and middle-income nations. Objective: This study assessed treatment outcome and predictors of Pediatric NHL at two pediatric oncology units in Ethiopia. Methods: A retrospective cohort study design was employed to analyze secondary data from two medical centers, Jimma University Medical Center and University of Gondar Comprehensive Specialized Hospital, from May 17, 2016, to December 30, 2024. Data on patient demographics, disease presentation, oncologic emergencies, and treatment outcomes were collected and analyzed. Survival estimates were calculated using the Kaplan-Meier method for the 111 patients whose treatment was initiated. Results: In this analysis, a total of 113 patients were included with a median age of 6.00 years. Males account for the majority (70.8%). Most patients (84.9%) presented with advanced disease (Stage 3 and 4). Burkitt lymphoma was the most prevalent subtype (61.1%), and the abdomen was the most common site of involvement. Nearly half of the patients (46.0%) presented with an oncologic emergency, predominantly Tumor Lysis Syndrome (26.5%). While 46.9% of patients completed treatment, a significant proportion (27.4%) abandoned care, and 23.9% died. The 5-year overall survival rate was 75.2%, and the 3-year event-free survival rate was 69.9%. Patients without oncologic emergencies before treatment had significantly higher odds of experiencing overall survival compared to those with emergencies (Exp(B) = 0.456, 95% CI [0.213, 0.978], p = 0.044). Conclusion and recommendation: Pediatric NHL in Ethiopia is characterized by late-stage presentation, a high burden of oncologic emergencies, and a predominance of Burkitt lymphoma. Despite these challenges, the observed 5-year survival rates are encouraging for a resource-limited setting. Notably, the absence of oncologic emergencies at the time of diagnosis was associated with significantly improved survival outcomes. However, high rates of treatment abandonment and mortality underscore the urgent need for targeted interventions. Efforts should focus on improving early diagnosis, enhancing supportive care, and addressing barriers to treatment adherence further to improve outcomes for children with NHL in Ethiopia