Evaluation of Inpatient Mortality in Pediatric Non-Hodgkin Lymphoma and Lessons Learnt at a Tertiary Care Hospital in Pakistan

Introduction: Non-Hodgkin Lymphoma (NHL) is an aggressive pediatric malignancy that carries dismal prognosis in developing countries.A mortality audit was done to identify causes of inpatient mortality in children with NHL at a tertiary care hospital.This is a descriptive study conducted at Pediatric Hematology Oncology Department at The Children's Hospital, Lahore from 1st January 2020 till June 2022.Methodology: Mortality analysis was done of pediatric NHL patients retrospectively.Demographics, clinical, and epidemiological features, histopathology, stage, and causes of death were analyzed.Mortality cause was categorized as treatment-related or disease-related mortality.Results: There were 42 mortalities out of 205 NHL patients.Thirteen patients (31%) had very early deaths.Thirty-eight percent were between 5 -10 years of age, 81% were boys and 81% 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 and High-grade B cell NHL (34%).Common causes of mortality were infection (57%), tumor lysis syndrome (19%), disease progression/resistance (10%), Superior vena cava syndrome (7%) and COVID infection (4%).Twenty-seven (64%) patients had treatment-related mortality while 15(36%) had disease-related mortality.