B Cell Non-Hodgkin's Lymphoma: Experience from a Tertiary Care Cancer Center

Information on presentation and outcome of B cell non-Hodgkin's lymphoma (B-NHL) is limited from developing countries. Data of newly diagnosed adult aggressive B-NHL (n = 260) patients were analyzed for clinical presentation, histological subtype, response to therapy, and survival. Univariate and multivariate Cox-regression analyses were performed for identification of prognostic factors. Diffuse large B cell lymphoma was the most common subtype (71 %). Median age was 50 years (18-78 years). The most common symptom was peripheral lymphadenopathy seen in 66 % of cases. Forty-seven percent of patients had advanced stage (stage III/IV), and 41 % had ECOG performance status of II-IV. B symptoms and bulky disease were present in 47 and 26 %, respectively. Intermediate to high risk score according to the International Prognostic Index (IPI) was seen in 67 %. Cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) and CHOP-like regimens were used in 70 % cases, while R-CHOP was used in 18 % cases. For diffuse large B cell lymphoma (DLBCL) patients, in intent-to-treat analysis, the overall response and complete remission rates were 73 and 60 %, respectively. Four-year event-free and overall survival was 54 and 64.7 %, respectively. Presence of B symptoms (p = 0.004), stage III/IV (p = 0.02/p = 0.01), performance status II-IV (p = 0.001), serum albumin (<4 g/dl; p = 0.001), hemoglobin <10 g/dl (p = 0.001), high-risk IPI score (0.001), use of <6 chemotherapy cycles (p = 0.001), and failure to attain CR (p = 0.001) were significantly associated with lower event-free and overall survival. DLBCL is the most common B cell NHL seen at our center. Intermediate to high IPI was seen in 45 % and was associated with poor survival. Majority of the patients were treated without rituximab. In comparison to western data, we observed higher proportion of DLBCL, lower median age, higher male to female ratio, and higher proportion of patients with B symptoms in our study.