Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt's Lymphoma

Syed Muhammad Ibne Ali Jaffari; Masooma Hashmi; Abdul Wasey Hashmi; Samaha Nisar; Hafsa Ashraf; Ghufran Tariq; Arslan Farooq; Javeria Awan; Syed Muhammad Jawad Zaidi; Mehwish Kaneez

doi:10.7759/cureus.40365

Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt's Lymphoma

Cureus. 2023 Jun 13;15(6):e40365. doi: 10.7759/cureus.40365. eCollection 2023 Jun.

Authors

Affiliations

¹ Pediatrics, Shalamar Medical and Dental College, Lahore, PAK.
² Internal Medicine, Walsall Manor Hospital, Royal Wolverhampton NHS Trust, Walsall, GBR.
³ Pediatrics, Arif Memorial Teaching Hospital, Lahore, PAK.
⁴ Internal Medicine, Combined Military Hospital, Lahore, PAK.
⁵ Pediatrics, Rawalpindi Medical University, Rawalpindi, PAK.
⁶ Pediatrics, Holy Family Hospital, Rawalpindi, PAK.
⁷ Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.

Abstract

Background Burkitt's lymphoma (BL) in the pediatric population has significant burden in developing countries. Infection-related complications during the induction chemotherapy phase pose a major challenge and contribute to high mortality rates due to a severely immunocompromised state. However, there is scarce data on the etiologies and optimal management strategies for infection-related mortality in pediatric BL patients, especially in developing countries like Pakistan. Methods This is a cross-sectional study that included a total of 116 pediatric patients with intermediate-risk BL. All patients were treated based on the Children's Cancer and Leukaemia Group (CCLG) 2020 guidelines. Data on patient demographics, presenting symptoms, diagnosis, infectious etiologies, and outcomes were collected. Infection-related complications and mortality were monitored during the induction chemotherapy period. The results of relevant culture reports were tabulated and data were analyzed. Results Among the 116 included patients, 61.1% were males with a mean age of 4.83 ± 2.12 years. Abdominal BL was the most common anatomical location. During the induction period, 66 patients (56.9%) had culture-proven infections, resulting in 33 deaths (28.4%). Fever was the predominant presenting symptom in all patients, followed by vomiting (57.6%), loose stools (42.4%), and cough (18.2%). Neutropenic colitis, sepsis, pneumonia, and meningitis were among the diagnosed infections. Hospital-acquired bacterial infections, including multi-drug resistant gram-negative and gram-positive organisms, were the main cause of mortality, with fungal infections and cytomegalovirus viremia also identified in a few patients. Conclusions This study highlights the urgent need for improved management strategies in pediatric BL patients in Pakistan to reduce infection-related complications and mortality rates, emphasizing the importance of context-specific approaches for infection prevention and management.

Keywords: bacterial infections; burkitt's lymphoma; induction chemotherapy; infection-associated mortality; intermediate risk.