DIFFUSE LARGE CELL LYMPHOMAS WITH RESTRICTED SOURCES

Context

Non-Hodgkin Lymphoma (NHL) encompasses a range of blood cancers originating in the lymphatic system, with Diffuse Large B-Cell Lymphoma (DLBCL) being the most prevalent type. In Kosovo, a country with limited healthcare resources, managing NHL remains a significant challenge. In 2024, Kosovo reported 60 cases of lymphoma, of which 53 were classified as NHL, and 24 of those were identified as DLBCL. The healthcare system faces numerous obstacles, particularly in providing specialized treatments such as Bone Marrow Transplantation (BMT), which is not available domestically. These limitations impact the diagnosis, management, and outcomes for DLBCL patients.

Aim

This study aims to explore the prevalence of DLBCL among NHL cases in Kosovo, identify the healthcare challenges posed by limited resources, and highlight the critical issue of the unavailability of bone marrow transplantation as part of lymphoma treatment.

Methods

Data from the Kosovo National Cancer Registry for 2024 shows that out of 60 lymphoma cases, 53 were NHL, and 24 were DLBCL. This retrospective study assesses the diagnostic, treatment, and follow-up data of these patients, focusing on challenges in managing DLBCL, especially the lack of bone marrow transplant services.

Discussion

Kosovo’s healthcare infrastructure is underdeveloped in terms of both diagnostic tools and treatment options for cancers like DLBCL. Early diagnosis, which is crucial for the successful treatment of DLBCL, is often delayed due to the lack of advanced imaging and molecular diagnostic techniques. Furthermore, chemotherapy regimens ‒ standard treatments for DLBCL ‒ are often delayed because of limited access to essential drugs, inadequate oncology training, and logistical issues in the healthcare system. A major issue is the absence of Bone Marrow Transplantation (BMT) services in Kosovo. BMT, a critical treatment for certain aggressive cases of DLBCL, is not available within the country, forcing patients to seek treatment abroad. This process is expensive, and many patients face financial barriers to accessing this life-saving procedure. For those who cannot afford treatment outside Kosovo, the lack of BMT options often leads to poorer outcomes, particularly for patients with relapsed or refractory DLBCL. Additionally, limited access to second-line treatments such as immunotherapy and targeted therapies exacerbates the situation. The healthcare system struggles with a shortage of specialized medical personnel and advanced cancer care facilities. The lack of access to BMT and modern therapies limits the treatment options available for patients who fail to respond to first-line chemotherapy, resulting in a worse prognosis.

Conclusion

Kosovo faces significant challenges in managing Diffuse Large B-Cell Lymphoma due to limited healthcare resources, particularly the unavailability of bone marrow transplantation. This limitation forces many patients to seek treatment abroad, which is not feasible for everyone due to financial constraints. Improving the country’s healthcare infrastructure, ensuring access to bone marrow transplantation, and strengthening the oncology workforce are essential steps toward improving patient outcomes. Additionally, international partnerships and funding are crucial in bridging these gaps and enhancing cancer care in Kosovo.