#37: Description of Moderate-Severe Cases of COVID-19 in Pediatric Cancer at the Unidad Nacional de Oncologia Pediatrica, Guatemala

Abstract

Introduction Guatemala reported the first confirmed SARS-CoV-2 case on March 13th 2020. Up to now, more than 140,000 confirmed cases have been documented, with 8% of them being <20 years-old. The impact of COVID-19 in pediatric cancer in not well known, even though pediatric oncological institutions did some initial recommendations, this new disease still represents a challenge in this population. The objective of the report is to describe the moderate-severe cases of COVID-19 in pediatric cancer during the first 8 months of the pandemic in the Unidad Nacional de Oncologia Pediatrica (UNOP). Methods This is a descriptive, prospective report of pediatric cancer patients <20 years-old and SARS-CoV-2 infection confirmed by nasopharyngeal swab with PCR technique at UNOP from May to December 2020. The SARS-CoV-2 test was performed to all patients who developed symptoms of infection or as screening in patients who were admitted to UNOP regardless of symptoms. Information about sex, age, primary oncological diagnosis, confirmed coinfections and treatment received at time of COVID-19 was collected. Moderate illness was considered if the patient required supplemental oxygen and severe illness if admitted to Intensive Care Unit -ICU- secondary to COVID-19. Results Two hundred one patients with pediatric cancer with the SARS-CoV-2 infection were confirmed. Sixty four percent were male (n=128), median of age was 9.5 years (5-m to 18-y). The primary oncologic diagnosis was leukemia 65% (n=129), and other solid tumors 35% (n=72), 5% (n=10) of patients were in palliative care. In leukemia patients, 40% were receiving induction therapy (n=51), 25% consolidation (n=32), and 19% maintenance (n=25). The most common initial symptom was fever in 32% (n=64) and 33% were asymptomatic (n=67). Twenty two percent developed moderate disease (n=44) and 13% severe disease (n=26). A total of 13 patients died during COVID-19 period (6%) and 7 of them died receiving active treatment (3%). The risk of developing moderate-severe disease was not higher in leukemia patients compared to patients with other tumors who were receiving intense chemotherapy (OR=0.7), but there might be a higher risk of death (OR=1.41). In patients with leukemia, the risk of developing moderate-severe disease was higher for patients receiving induction therapy compared with those in consolidation (OR=6.7) or maintenance (OR=3.04). Mortality risk seems to be higher in patients with leukemia during induction therapy (OR=1.94). Confirmed coinfections correlated with higher risk of severe illness (OR=1.95) and death during the COVID-19 period (OR=5.2). Conclusions The mortality due to COVID-19 in pediatric cancer is low and could be related to coinfections or intensive chemotherapy. Important limitation of our report is the lack of analysis of underlying clinical conditions in moderate-severe disease (neutropenia or other comorbidities), factors that could have an impact on our data analysis.

Challenges in Treating Pediatric Cancer Patients during the COVID-19 Pandemic: Balancing Risks and Care

“…Although COVID-19 infection in children is usually uncomplicated, the fragile state of children with cancer may increase the impact of SARS-CoV-2 or favor a coinfection that complicates disease progression. A study by Escobar et al (2021), which included 201 children with cancer infected with SARS-CoV-2, reported that confirmed coinfections correlated with an increased risk of severe disease (OR = 1.95) and death (OR = 5.2) [73]. In another study of 131 patients diagnosed with cancer or hematopoietic stem cell transplantation who were PCR-positive for SARS-CoV-2, bacterial coinfections (Escherichia coli, Staphylococcus aureus, and Mycobacterium tuberculosis) were observed in seven patients, five patients had viral coinfections (cytomegalovirus, enterovirus/rotavirus, parainfluenza, and herpes simplex virus), three patients had invasive fungal infections (Aspergillus spp., Pneumocystis jirovecii, and Candida tropicalis), and coinfections were significantly associated with increased disease severity (1.74; 95% CI: 1.03-3.03) [74].…”