Thesis (M.Sc.) - Cairo University - National Cancer Institute - Department of Pediatric Oncology

Background/objective; The outcome of childhood Burkitt{u2019}s lymphoma (BL) has improved steadily over the past decades with intensive chemotherapy regimens but chemotherapy-Induced neutropenia (CIN) remains the most serious and the major dose-limiting toxicity of systemic chemotherapy. This study objective was to assess the morbidities and mortalities of infectious episodes during induction phase chemotherapy. Methods: A retrospective study including all patients 18 years old or younger diagnosed with BL and treated according to the modified LMB 96 protocol at the National Cancer Institute, Cairo university from January 2016 to December 2019 and their follow up till June 2020. Results:There were303 infectious episodes in 152 patients.Typhlitis/colitis was the commonest clinically documented infection (54.4%), followed by mucositis (40.5%), and chest infection/pneumonia (38.2%). In the microbiologically documented episodes, Gram negative organisms represented 57%. The main cause of death was likely sepsis (65.4%). Mortality was higher in group C patients (18.8%) compared to group B patients (7.8%). There were no mortalities in group A patients (P value = 0.011). Mortality of microbiologically documented episodes represented 78.8% (P value <0.001), including those of multidrug resistant Gram negative bacteremia representing 37.2 % (P value <0.001). Among predictors of outcome, thrombocytopenia, anemia, impaired electrolytes, and impaired liver and renal function tests, were associated with higher mortality rate (37.3%, 20.2%, 25.2%, 37.5%, and 72.7% respectively) (P value <0.001). Additionally, poor general condition before starting chemotherapy, presence of active disease, and earlier onset of fever and neutropenia were associated with poorer outcome (P value <0.001)

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