EVALUATION OF INPATIENT MORTALITY IN PEDIATRIC NON-HODGKIN LYMPHOMA AND LESSONS LEARN AT A TERTIARY CARE HOSPITAL IN PAKISTAN

INPATIENT MORTALITY IN PEDIATRIC NON-HODGKIN LYMPHOMA

Abstract

Background Non-Hodgkin Lymphoma (NHL) is an aggressive pediatric malignancy. Treatment outcomes have improved in developed countries, but prognosis is still dismal in developing countries. Causes of mortality are variable and scarce data is available from developing countries to accurately identify them. Clinical audit was done so as to identify causes of inpatient mortality of children with NHL at a tertiary care hospital in a developing country and to recommend interventions that can help reduce the mortality.

Materials & Methods: Clinical audit conducted in pediatric Hematology Oncology department at The Children’s Hospital, Lahore, Pakistan from 1^st January 2020 till June 2022. Mortality analysis was done of pediatric NHL patients retrospectively in respect to demographics, clinical, epidemiological features, histopathology, stage and causes of death. Mortality cause was categorized as treatment related or disease related mortality.

Results: Total 205 NHL patients were diagnosed during the study period. There were 42 mortalities. Thirty eight percent were between 5 -10 years of age, 81% were boys and 70% were from other cities. Predominant symptoms were Fever (52%), abdominal pain/distension (38%), Respiratory distress (33%) palpable mass (21%) and lymphadenopathy (21%). Histopathology was T Lymphoblastic Lymphoma (22%), Burkitt’s Lymphoma (17%), High grade B cell NHL (17%). Common causes of mortality were sepsis (29%), febrile neutropenia (22%), Acute renal failure (10%), Tumor Lysis syndrome (9%), disease progression (10%), Superior vena cava syndrome (7%) and COVID infection (4%). Twenty-two (52%) patients had treatment related mortality while 20(48%) had disease related mortality.

Conclusion: Treatment and disease related complications still constitute a common cause of inpatient pediatric NHL deaths. Infection is still the biggest cause of mortality. Significant number of children presented with Oncological emergency. There is need for early diagnosis, more pediatric Oncology units, training of pediatricians to deal with oncological emergencies and better supportive care to improve patient outcomes.