CLINICAL HETEROGENEITY AND IMPACT OF TREATMENT INITIATION TIME IN NON-HODGKIN LYMPHOMA

Abstract

Objectives: This study aimed to analyze the clinical presentation of non-Hodgkin lymphoma (NHL) patients, focusing on age distribution, time to treatment initiation, and overall survival. It also sought to identify differences in these parameters across various NHL subtypes, including Burkitt lymphoma. Material and methods: We conducted a cross-sectional study involving NHL patients treated in the hematology ward at Hospital Geral de Fortaleza. Data on clinical parameters such as age, time to chemotherapy, and time to death were collected. We summarized these variables using medians and interquartile ranges (IQR). Non-parametric tests, specifically the Mann-Whitney U-test, were used for group comparisons, with p-values < 0.05 considered statistically significant. Overall survival (OS) was assessed using the Kaplan-Meier method, with a 95% confidence interval and p-values < 0.05 deemed significant. Results: The study included patients with various NHL subtypes, including Burkitt lymphoma (n = 5), diffuse large B-cell lymphoma (DLBCL, n = 11), high-grade B-cell lymphoma (n = 5), NK/T-cell nasal lymphoma (n = 1), plasmablastic lymphoma (n = 1), and primary CNS lymphoma (n = 6). Median ages were as follows: Burkitt lymphoma, 32 years (IQR: 25.0-50.0); DLBCL, 39 years (IQR: 35.0-49.5); high-grade B-cell lymphoma, 26 years (IQR: 20.0-39.0); NK/T-cell nasal lymphoma, 37 years; plasmablastic lymphoma, 26 years; and primary CNS lymphoma, 45.5 years (IQR: 39.8-52.0). These variations underscore the clinical heterogeneity and the need for tailored treatment strategies. Analysis showed significant variability in the median time to initiating chemotherapy among subtypes. Burkitt lymphoma patients had a median initiation time of 32 days, which was later than the 17 days for DLBCL patients. High-grade B-cell lymphoma patients had the longest median time to treatment initiation at 48 days, suggesting possible delays in diagnosis or treatment. These findings highlight the need for improved diagnostic and therapeutic strategies, especially for subtypes with longer initiation times. The overall survival rate was 37.5% at two years, which is lower compared to international data. Time to treatment initiation was particularly associated with worse outcomes in patients with primary CNS lymphoma (PNCSL), with delays in tissue evaluation contributing to challenges. Discussion: The study revealed significant differences in median ages across lymphoma subtypes, reflecting the clinical diversity and the need for personalized treatment approaches. Notably, patients with Burkitt lymphoma and high-grade B-cell lymphoma experienced delays in starting treatment. High-grade B-cell lymphoma patients had the longest median time to treatment initiation, highlighting potential diagnostic and treatment delays. The overall survival rate of 37.5% at two years was concerning, especially when compared to international data. Delays in initiating treatment were linked to poorer outcomes, particularly in PNCSL patients, with issues in tissue evaluation by stereotaxic samples being a significant hurdle. Conclusion: The findings emphasize the critical need for prompt diagnosis and timely treatment initiation to improve patient outcomes. The delays in treatment initiation, particularly for high-grade B-cell lymphoma and Burkitt lymphoma, underscore the importance of streamlining diagnostic and therapeutic processes.