Early treatment-related mortality and morbidity of children with non-Hodgkin lymphoma treated at Tikur Anbessa specialized hospital with modified ALCL protocol:Prospective Cohort Study.
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Date
2024-09
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Addis Ababa University
Abstract
Background: - Childhood non-Hodgkin lymphoma is a varied collection of malignant neoplasms that
includes all lymphomas that are not categorized as Hodgkin lymphoma. It is the third most prevalent
malignancy after leukemia and brain tumors. Over the last twenty years, significant improvements in
chemotherapy combination, intensification, and supportive care have led to significant survival in high-
income countries. However, in low- and middle-income countries, underlying malnutrition, delayed and
advanced presentation, inadequate supportive care, and infection will all lead to poor overall outcomes
and treatment-related early or late mortality; this study aimed to Assess, early induction phase treatment-
related mortality and associated factors of children with non-Hodgkin’s Lymphoma treated at TASH
treated with modified ALCL protocol.
Methods: - A hospital-based Prospective cohort study design was conducted on a total of 50 children
with confirmed non-Hodgkin’s lymphoma treated at Tikur Anbesa specialized hospital from March 2023
to June 2024. data were collected using a structured questionnaire and entered into Epi Data 3.1 then
exported to SPSS for analysis. The categorical variables in the study were presented using frequency, and
percentage, and compared between groups using the chi-square test. Multivariate logistic regression
analysis, cox proportional hazard ratio, and Kaplan Meier analysis were performed to analyze the survival
and factors associated with early treatment-related mortality.
Results: the mean age at diagnosis was 5 years; abdominal swelling and constitutional symptoms like
fever and weight loss were the common presenting complaints. Burkitt lymphoma accounts for 40% of
the diagnosis and the majority of the patients present with advanced stage of the disease with elevated
LDH (86%), and stage III/IV disease (92%). The majority of the patients had one or more oncologic
emergencies at presentation the commonest being TLS (56%) and infection (32%). Infectious
complications, hematologic toxicity, mucositis, and typhlitis were the commonly encountered
chemotherapy-related toxicities and 24% of patients died during the induction phase.
Conclusion: The induction phase of treatment resulted in a significantly high death rate (24%) for
children and adolescents with NHL who were treated by the locally modified ALCL protocol.
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Keywords
Childhood, Non-Hodgkin lymphoma