Research Article
Volume 9 Issue 3
Ajaya Kumar Jha*, Garima Subedi and Arvind Kumar Sinha
September 18, 2026
Abstract
Despite favorable outcome of Hodgkin lymphoma approximately 25% of patient’s experience relapse or refractory to initial treatment. Non-Hodgkin Lymphoma is clinically and biologically a diverse group of disease ranging from indolent to aggressive clinical course. Diffuse large B cell variant is clinically aggressive course while follicular, Marginal zone lymphoma are indolent. Response rate to conventional chemotherapy is more than fifty percent however in significant proportion do relapse. Several factors are considered for adopting salvage regimen including autologous bone marrow transplant. Novel emerging treatment are also under current practice. A retrospective clinic -pathological profile and treatment outcome of relapsed lymphoma cases at Vayodha Hospital from January 2022 to February 2026. Retrospective chart review of patients diagnosed as relapsed lymphoma and got treated were enrolled in the study over 50 months’ period. Total of 20 adult patients were enrolled in the study. Biopsy was done in all cases and disease classification was done according to histomorphology and immunohistochemistry. Staging was done by PET CT/CECT. From January 2022 to February 2026, twenty cases were registered with relapsed lymphoma. Mean age of presentation was 42.5 years (range 21-72 years). Male: female ratio was 2.3:1. During this period four patients with Hodgkin lymphoma and sixteen patients with Non-Hodgkin Lymphoma relapsed. Biopsy was done in all and further subtyping was done on the basis of histomorphology and immunohistochemistry. Staging and response evaluation of treatment was done by PET CT in 55% while contrast enhanced CT was done in 45%. All Hodgkin lymphoma were treated with ABVD regimen prior to relapse while Non-Hodgkin lymphoma was treated with Rituximab based regimen in majority 75%. Median time to relapse was 36 months. Majority (80%) was documented as late relapse and nodal disease in 55%. Extra nodal were 45% and sites were Brain & spine (25%), orbit, bone marrow, gastrointestinal tract, nasopharynx and spleen. Diffuse large B cell histology was found in 56%. Mantle cell (19%), T cell rich B cell (12.5%), Follicular and MALT lymphoma each 6% are other histological types. Chemotherapy based salvage regimen was used in 80% and autologous bone marrow transplant after salvage was opted in 10% and remaining 10% was treated with only palliative care. DHAP (Dexamethasone, Ara-C, Cisplatin) regimen was used in 45%. Outcome analysis revealed 70% alive and deaths were recorded in 30% due to progressive and refractory disease. Mean duration of follow up since first diagnosis was 64.5 months (range: 8 - 96 months). Relapse poses significant challenges in resource poor country. Limited diagnostic facilities and poor patient finance poses difficulty in planning treatment strategy. Standard salvage followed by bone marrow transplant is limited due financial constraint and limited facility as well.
Keywords: Lymphoma; Bone marrow transplant; Non-Hodgkin lymphoma and Nepal
References