Assessment of Selected Immunophenotypic Markers in Childhood Non-Hodgkin's Lymphomas in Ghana: A Possible Tool for Effective Stratification of Patients and Assessment of Survival Outcomes

Abstract

Background

Non-Hodgkin lymphomas (NHL) represent a heterogeneous group of malignancies with varying molecular and immunophenotypic characteristics. In Ghana, NHL is the third most common childhood cancer, highlighting the need for precise diagnostic approaches to improve survival rates. The identification of immunophenotypic biomarkers expressed by both healthy and neoplastic cells of the immune systems has been shown to provide information on the diagnostic and prognostic characterization of tumors leading to personalized treatment of NHL. We evaluated the immunophenotypic profiles of pediatric NHL and their correlation with survival outcomes.

Aims

This study aimed to evaluate the immunophenotypic characteristics of three subtypes of non-Hodgkin lymphoma (NHL) and their associated survival outcomes among children diagnosed at Komfo Anokye Teaching Hospital, Kumasi.

Methods

In this retrospective study, 38 NHL patients were recruited from the Komfo Anokye Teaching Hospital from 2018 to 2022. Clinico-pathological characteristics and treatment outcome were obtained in patients' folders. Formalin fixed paraffin embedded tissues were histologically examined and immunohistochemistry performed using monoclonal antibodies targeting CD3, CD25 and BCL-2. The Kaplan–Meier method was used to obtain survival curves and compared by the log-rank test. Statistical analysis was performed using SPSS (version 26.0) and XLSTAT.

Results

Females accounted for 55.3% of cases, with most patients being under 10 years. Within the first-year post-diagnosis, 30.6% of children died, and 27.8% abandoned treatment. BCL-2 was the most frequently expressed marker (55.3%), with co-expression observed across all lymphoma types and age groups. Survival analysis was performed on 21/38 participants with complete follow-up data. The median survival time was 22 months (95% CI: 3.96–40.11), with survival rates declining from 76% at 10 months to 20% at 40 months. Factors significantly associated with poor survival included BCL-2 expression (poorer survival) and extranodal spread (p < 0.05).

Conclusion

The survival rate for NHL patients in Ghana is very low. BCL-2 was the most expressed marker, significantly influencing survival outcomes. The extent of tumor spread also influenced survival outcomes. Identifying prognostic factors for early diagnosis and treatment is essential to improving survival outcomes for NHL patients in this setting.