WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Zakariya Zuhair Al Hayali* MBChB CABP, Reyad Ebraheem Hussien MBChB CABP, Iman Idriss Yaseen MBChB FIBMS/FM

ABSTRACT

Background: In contrast to adult non-Hodgkin lymphoma (NHL), which is typically indolent, childhood NHL is characteristically high-grade, aggressive, and highly proliferative. Objective: To evaluate the epidemiological parameters, clinical presentation, histopathological subtypes, and therapeutic outcomes of pediatric NHL at a specialized oncology unit in Mosul. Materials and Methods: A retrospective randomized study reviewed 60 pediatric patients aged 1–14 years admitted to the Pediatric Oncology Unit of Ibn Al Atheer Hospital from April 1, 2017, to February 28, 2018. Patients were treated using the FAB/LMB 96 protocol. Results: The study cohort had a mean age of 5 years, with 71.6% (n = 43) aged <=5 years. Males predominated with a male-to-female ratio of 2.75:1. The mean duration of symptoms prior to diagnosis was 4 weeks, with 75% presenting within 4–6 weeks. The primary site of involvement was the abdomen in 61.6% (n = 37) of cases, presenting as an abdominal mass (43.4%) or abdominal pain (18.4%). Peripheral lymphadenopathy was the primary feature in 28.4% (n = 17). Major associated clinical findings included pallor (56.7%), fatigue (26.7%), and anorexia (21.7%). Anemia was present in 38.4% (n = 23), with a mean hemoglobin of 8 g/dl. All patients presented with advanced disease (91.7% in Stage III and 8.3% in Stage IV). Histopathologically, Burkitt lymphoma was the dominant subtype, accounting for 91.6% (n = 55) of cases, followed by lymphoblastic lymphoma (6.7%, n = 4) and diffuse large B-cell lymphoma (1.7%, n = 1). Therapeutic evaluation demonstrated a successful completion rate of 86.7% (n = 52), while the mortality rate was 11.7% (n = 7). The primary causes of death were bacterial sepsis/neutropenic fever (8.3%, n = 5) and tumor lysis syndrome (3.4%, n = 2). Conclusion: Pediatric NHL in Nineveh is highly aggressive, predominantly affects males under 5 years of age, and presents almost exclusively at advanced stages. Burkitt lymphoma is the dominant variant. Despite the aggressive presentation, multi-agent chemotherapy protocols yield high remission rates.

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