Chemotherapy Outcomes Among Pediatric Cancer Patients with Active COVID-19 Infection in a Tertiary Hospital

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Abstract Background The impact of COVID-19 on pediatric cancer patients undergoing chemotherapy remains a significant concern due to their immunocompromised state. Balancing the risks of chemotherapy-induced immunosuppression against the dangers of delaying cancer treatment is a critical challenge, with limited evidence to guide practice. Objective This study aimed to describe the clinico-demographic characteristics and determine the post-chemotherapy outcomes of pediatric cancer patients with active COVID-19 infection. Methods A retrospective, cross-sectional study was conducted on 34 pediatric cancer patients with RT-PCR-confirmed COVID-19 who received chemotherapy between July 2020 and December 2023 at a government tertiary hospital. Data on demographics, cancer profile, clinical presentation, diagnostic parameters, and outcomes (discharge status, febrile neutropenia, ICU admission, length of stay, etc.) were collected and analyzed using descriptive statistics and association tests. Results The cohort was predominantly male (76.5%), aged 1-5 years (35.3%), with hematologic malignancies (60%). Most patients had asymptomatic (35.3%) or mild (44.1%) COVID-19. Febrile neutropenia occurred in 34.3% of cases. The overall mortality rate was low (2.9%), with one non-COVID-related death. ICU admission was required in 5.9% of cases, all with severe COVID-19. Disease severity was significantly associated with febrile neutropenia (p=0.000) and nosocomial infection (p=0.005). Absolute neutrophil count (ANC) was significantly associated with ICU admission (p=0.001). Most patients (97.1%) were discharged alive. Conclusion Pediatric cancer patients with COVID-19, particularly those with mild or asymptomatic infection, can continue chemotherapy with favorable outcomes. Disease severity and elevated ANC are significant predictors of complications. These findings support the individualized continuation of cancer therapy during active infection. Further prospective studies are recommended to establish standardized guidelines.