Medical & Clinical Research

Author(s): Ajaya Kumar Jha, Garima Subedi and Arvind Kumar Sinha

Non-Hodgkin Lymphoma is a common hematological malignancy. Clinically and biologically a diverse group of disease ranging from indolent to aggressive clinical course. Diffuse large B cell variant is clinically aggressive course while follicular, Marginal zone lymphoma are indolent. Individual risk categorization based on immunohistochemistry, molecular study and nuclear image-based response criteria has resulted in increased response and survival in last two decades. Our objective was to study clinical profile, treatment and outcome of patients diagnosed as Non-Hodgkin Lymphoma at our center. Retrospective chart review of patients diagnosed as Non-Hodgkin lymphoma and got treated were enrolled in the study from January 2018 to December 2023 and followed up them up to June 2025.  Demographic, clinical profile, treatment and outcome were analyzed for event free survival (EFS) and overall survival (OS).  Total of 55 adult patients were enrolled in the study. From January 2018 to December 2023, fifty-five cases were registered with Non-Hodgkin lymphoma. Mean age of presentation was 45.3 years (range 19-76 years). Male: female ratio was 1.75:1. Majority (42%) belonged to age group of 40-60 years and 76% patients had duration of symptoms between 1-3 months. B symptoms were documented in 24%. Nodal presentation (56%) was more common than Extra nodal (44%). B-cell disease (94.5%) was more common than T cell (5.5%). DLBCL was the most common histological subtype (71%) followed by Mantle cell, Follicular, Splenic Marginal Zone, MALT lymphoma. Among T cell histology, ALK positive T cell, Peripheral T cell and NK/T cell were common. Staging and response evaluation was done by CECT in 89% while PET CT was done in 11%. Majority 58% belonged to stage 2 disease while one third 33% belonged to advanced stage. CHOP (Cyclophosphamide, Vincristine, Doxorubicin, Prednisolone) based regimen was adopted in 74.5%, Bendamustine (B-R) based in 18%, CVP (Cyclophosphamide, Vincristine, Prednisolone) in 5% and one patient was treated by SMILE protocol. Rituximab was used in 53% and three (5.4%) received Radiotherapy as well. Outcome analysis revealed 37(67%) were alive during follow-up and 18 (33%) relapsed. Those who relapsed 7(13%) died due to relapse/refractory or progressive disease.  Mean duration of follow up since first diagnosis was 66.8 months (range: 8 – 96 months). Non-Hodgkin Lymphoma presents in fourth decade of life in majority. B cell lymphoma is the most common and DLBCL histology predominates. Financial restriction influences in adopting advanced investigation and treatment modalities. Almost one third had relapse. Relapse poses significant challenges in resource poor country.