Early treatment-related morbidity and mortality of children with non-Hodgkin's lymphoma treated at Tikur Anbesa Specialized Hospital with modified ALCL protocol: prospective cohort study.

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 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 Tikur Anbesa Specialized Hospital (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 TASH 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 tumor lysis syndrome (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.