Comparison of the stages and sociodemographic characteristics of patients diagnosed with lymphoma before and during the COVID-19 pandemic

Introduction and Aim: Lymphomas are tumors caused by clonal overproliferation of B lymphocytes, T lymphocytes or NK cells, which can be cured if detected at an early stage. Revised Ann Arbor criteria (Lugano classification) are used for staging. The COVID -19 pandemic has created a widespread problem in the world, disrupting services in many areas, especially in the health sector. As with all diseases, there have been disruptions at every stage of the screening, diagnosis and treatment process in malignant diseases. In our study, we aimed to investigate the possibility of lymphoma patients to be diagnosed at a later stage and to be admitted to the hospital later during the pandemic. Materials and Methods: In our retrospective study, 645 lymphoma patients, 143 during the pandemic period (March 2020-March 2022) and 502 in the pre-pandemic period (March 2012-March 2020), were included in Bezmialem Foundation University Hospital Hematology Department. Information on age, gender, lymphoma type, stage, B symptoms, spleen and bone marrow involvement were obtained from 138 HL and 507 NHL patients. Patients admitted in the two years after the pandemic were statistically compared with both patients admitted in the two years before the pandemic (March 2018-March 2020) and all patients admitted in the pre-pandemic period (March 2012-March 2020). Results: We found that 68% of all patients were diagnosed at advanced stage. Stage distribution in order of frequency: Stage 1 (8.6%), Stage 2 (22.9%), Stage 3 (22.6%), Stage 4 (46%). Among patients diagnosed with HL, both those who presented in the 2 years before the pandemic and all patients before the pandemic were compared with pandemic patients in terms of gender, stage, B symptom, bone marrow and spleen involvement, and no statistically significant difference was found (p>0.05). The mean age of HL patients after the pandemic was found to be statistically significantly lower than before the pandemic. Nodular lymphocyte predominant HL was found to be higher after the pandemic (p=0.036). When all patients diagnosed with NHL both in the 2 years before the pandemic and before the pandemic were compared with pandemic patients in terms of age, gender, stage and bone marrow involvement, no statistically significant difference was found (p>0.05). Spleen involvement was higher after the pandemic (p<0.001). Among the NHL subtypes, B-cell high-grade (aggressive) lymphoma without subtyping was significantly higher after the pandemic (p<0.001). Conclusion: The low average age of HL patients after the pandemic may be due to the fact that the elderly population remained more isolated due to pandemic measures or that the elderly population died before being diagnosed with lymphoma due to Covid-19 infection. Although nodular lymphocyte predominant HL, one of the HL subtypes, was statistically higher after the pandemic, it cannot be generalized due to the small number of patients before and after the pandemic. We think that the higher incidence of B-cell high-grade lymphoma without subtyping and increased spleen involvement in NHL patients after the pandemic may be related to the Covid-19 infection of the patients.