High treatment related mortality due to infection remains a major challenge in the management of high-grade B-cell Non-Hodgkin Lymphoma in children in developing countries: Experience from a tertiary cancer center in Eastern India

Abstract

BackgroundThough the outcome of high-grade B-cell Non-Hodgkin Lymphoma (B-NHL) has improved significantly in recent years, but the treatment related toxicity is still high. ObjectivesTo study the demographic characteristics, outcome, and toxicity of FAB/LMB 96 backbone in pediatric patients with B-NHL. Materials and methodsA retrospective single center review of records of all patients <18 years of age with B-NHL treated on FAB/LMB 96 protocol at a tertiary cancer center between January 2011 to January 2020. ResultsOut of the total 47 patients, there were 44 males and 3 females. Median age of presentation was 8 years 9 months. Total patients allocated to group A, B and C were 3 (6.4%), 29 (61.7%), and 15 (31.9%) respectively. With median follow up of 20 months, 2-year overall survival (OS) and event-free survival (EFS) for the whole cohort was 73.4% and 72.8%, respectively. The 2-year OS and EFS for group A, B and C were 100%, 82.6%, 45.7% and 100%, 81.9%, 45.0% respectively. There were total 13 deaths out of which 8 (61.5%) were treatment related mortality (TRM). Almost all of the TRM (7/8; 83.3%) were due to multi-drug resistant organism (MDRO) sepsis. ConclusionsThis study shows outcomes comparable to other centers in low and intermediate risk patients. Children with high-risk disease however have poor outcome due to high MDRO sepsis related mortality, a finding consistently shared across other centers in resource limited settings. This emphasizes on the need for newer strategies in this group of patients probably as an InPOG prospective multicenter trial including immunotherapy and chemotherapy backbone according to local practicalities. In contrast to the recently published Indian study, we did not find excess toxic deaths in our cohort of patients receiving rituximab.