Clinicopathological Profile, Treatment Response, and Survival Outcomes of Non-Hodgkin Lymphoma Patients in Southern Iraq: A Retrospective Cross-Sectional Study

Abstract

Introduction: Non-Hodgkin Lymphoma poses a significant health burden, yet detailed epidemiological and clinical data from Southern Iraq are lacking. Understanding local disease patterns is essential for developing effective, region-specific cancer control programs. This study aimed to describe the demographic and clinicopathological characteristics of NHL patients in Nasiriya, Iraq, and to evaluate their treatment response and survival outcomes across different subtypes and disease stages.

Materials and Methods: A retrospective cross-sectional study was conducted at Al Nasiriya Teaching Hospital from 2017 to 2022. Data from 213 adult patients with histologically confirmed NHL who received at least three cycles of first-line chemotherapy were abstracted. Variables included demographics, disease characteristics, laboratory parameters, treatment response (interim and end-of-therapy), overall survival (OS), and progression-free survival (PFS).

Results: The cohort’s median age was 53 years with a male predominance (54.9%). Diffuse Large B-cell Lymphoma (DLBCL) was the most common subtype (69.5%). Nearly half (46.9%) presented with advanced-stage (III/IV) disease. The interim complete response rate was 70%, declining slightly to 66.2% at end-of-therapy. Response varied significantly by subtype; PTCL NOS had the lowest interim CR rate (35.3%), while MZL and SMZL had the highest (92.9-100%). OS differed significantly by subtype (p=0.043) and was most powerfully predicted by disease stage (p<0.001), with Stage III/IV conferring a threefold higher mortality risk (HR ~2.8-3.1) compared to Stage I. PFS showed a similar strong association with advanced stage (p<0.001).

Conclusion: This study reveals a high burden of aggressive, late-stage NHL in Southern Iraq, dominated by DLBCL. While first-line therapy is generally effective, PTCL NOS is a high-risk subtype with poor outcomes. Advanced disease stage is the paramount prognostic factor, highlighting an urgent need for public health strategies to enable earlier diagnosis and subtype-specific treatment optimization to improve survival.