Advanced and More Symptomatic B-Cell Non-Hodgkin Lymphoma at Diagnosis After COVID-19 Disruptions in a Romanian Tertiary Center

Background B-cell non-Hodgkin lymphoma (B-NHL) requires timely tissue diagnosis, staging, and therapeutic planning, the clinical trajectory being shaped from the outset by stage at presentation, tumor burden, symptom burden, and organ involvement; against that background, pandemic-related disruption of non-COVID services raised concern that patients with hematologic malignancies might re-enter care later and in less favorable clinical condition. This study evaluated whether the post-pandemic recovery in case numbers at a Romanian tertiary center was accompanied by a shift toward more advanced and more symptomatic disease at diagnosis. Methods This retrospective single-center study included adults newly diagnosed with B-NHL at the Sibiu County Emergency Clinical Hospital between March 11, 2018, and March 7, 2024. The cohort was stratified into pre-pandemic, pandemic, and post-restriction intervals to capture the clinical consequences of successive healthcare contexts. Patients were eligible if they had at least two standard inpatient admissions within the corresponding period, day-hospital admissions being excluded, and records that were incomplete, inconsistent, or clearly erroneous also being removed. Demographic, clinicopathologic, treatment-related, and selected laboratory variables were analyzed. Results Of 585 lymphoma records initially identified, 366 met the general eligibility criteria, and 123 met the study-specific criteria for newly diagnosed B-NHL, including 43 pre-pandemic cases, 35 pandemic cases, and 45 post-restriction cases. Although the histopathologic spectrum remained broadly stable, diffuse large B-cell lymphoma continuing to predominate throughout, the post-restriction interval was marked by a redistribution toward more advanced disease, with advanced stage III-IV cases increasing from 25 patients before the pandemic and 21 during the pandemic to 34 after restrictions, while stage IV disease increased from 16 and 13 cases in the first two intervals to 22 cases in the post-restriction interval. Additionally, the proportion of patients without B-symptoms fell from 53.5% and 62.9% in the first two intervals to 11.1% thereafter. Conclusions In this cohort, the numerical recovery in newly diagnosed B-NHL cases after the pandemic was accompanied not by full clinical normalization, but by a more advanced and more symptomatic pattern of presentation, the overall findings being compatible with delayed access to timely lymphoma evaluation and with the persistence of downstream effects even after formal service reopening.