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This study aims to evaluate long-term survival and identify factors influencing mortality in adults with diffuse large B-cell lymphoma (DLBCL) in Northwest Ethiopia, particularly focusing on the HIV-positive population.

March 16, 2026Open Access

Five-Year Survival and Determinants of Diffuse Large B-cell Lymphoma in Resource-Limited Settings: The Impact of HIV/AIDS in a Multi-Center Cohort Study

Key Points

This study aims to evaluate long-term survival and identify factors influencing mortality in adults with diffuse large B-cell lymphoma (DLBCL) in Northwest Ethiopia, particularly focusing on the HIV-positive population.
Conducted a multicenter retrospective cohort study.
Included adults with newly histologically confirmed DLBCL diagnosed between August 2020 and July 2025.
Followed patients until death, loss to follow-up, or study end.
Used Kaplan–Meier method to estimate overall survival and Cox regression for mortality predictors.
175 patients with DLBCL were included; 31 (17.7%) were HIV-positive.
Median survival time was 36 months (IQR: 21–49).
Estimated 5-year overall survival was 25%.
Advanced disease, HIV status, elevated serum LDH, and delayed chemotherapy initiation were linked to increased mortality.
Neutropenic fever was the sole independent predictor of death among HIV-positive patients.

Abstract

Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma and a leading cause of cancer-related mortality worldwide. Evidence on long-term survival and prognostic determinants remains limited, particularly among people living with HIV. This study evaluated survival outcomes and predictors of mortality among adults with DLBCL in Northwest Ethiopia. Methods We conducted a multicenter retrospective cohort study of consecutively enrolled adults with newly histologically confirmed DLBCL diagnosed between August 1, 2020, and July 31, 2025, at three referral hospitals in Northwest Ethiopia. Patients were followed from diagnosis until death, loss to follow-up, or study end. Overall survival (OS) was estimated using the Kaplan–Meier method. Cox proportional hazard regression was used to identify independent predictors of mortality. Subgroup analyses were performed depending on HIV status. Statistical significance was set at P ≤0.05. Results A total of 175 patients with DLBCL were included, of whom 31 (17.7%) were HIV-positive. The median survival time was 36 months (IQR: 21–49). The estimated 5-year OS was 25%. Advanced disease (stage IV; AHR = 2.7, 95% CI: 1.1–6.5), HIV-positive status (AHR = 2.3, 95% CI: 1.1–5.0), elevated serum lactate dehydrogenase (LDH) (≥2× upper limit of normal; AHR = 2.2, 95% CI: 1.0–4.9), and delayed initiation of chemotherapy (≥2 months; AHR = 2.6, 95% CI: 1.2–5.8) were independently associated with increased mortality. Among HIV-positive patients, neutropenic fever was the sole independent predictor of death (AHR = 4.3, 95% CI: 1.1–17.4). Conclusions Survival among patients with DLBCL in Northwest Ethiopia remains poor, particularly among those presenting with advanced disease, those living with HIV, those that have delayed treatment initiation, and those that have elevated serum LDH – all these parameters were independently associated with increased mortality. Strengthening diagnostic capacity, ensuring equitable access to immunochemotherapy, integrating HIV–oncology services, and prioritizing early treatment initiation are essential to improving outcome.

Five-Year Survival and Determinants of Diffuse Large B-cell Lymphoma in Resource-Limited Settings: The Impact of HIV/AIDS in a Multi-Center Cohort Study

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