Childhood B-Cell Acute Lymphoblastic Leukemia Following SARS CoV-2 Infection: A Potential Second “Hit” in Leukemogenesis

Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic has become the worst pandemic in modern history. The lack of prior immunity to the virus has resulted in a high mortality rate, though children have fared better than adults, overall. We present a case of a child who developed B-cell acute lymphoblastic leukemia 1 week following a symptomatic COVID-19 infection. It is possible that this viral infection provided the “second hit” posited to occur in pediatric leukemogenesis as proposed by Dr Greaves, with his initial viral exposure occurring several weeks earlier.

The impact of the COVID‐19 pandemic on the future incidence of acute lymphoblastic leukaemia in children: Projections for Germany under a COVID‐19 related scenario

“…Single cases of BCP‐ALL shortly after SARS‐CoV‐2 infection may support this scenario. 7 On the other hand, its possible impact could be that the social isolation of susceptible children during the COVID‐19 pandemic would generally reduce the risk of experiencing a second, infectious hit.…”

Isolated CNS Relapse in 2 High-Risk B-cell Acute Lymphoblastic Leukemia Patients Following SARS-CoV-2 Infection

“…22 It has been postulated that COVID-19 could act similarly, raising concern that we will see increased rates of pediatric ALL as a consequence of the current pandemic. [10][11][12] While Greaves' model addresses ALL development, we conjecture that the aberrant immune response he describes as a modulating event in leukemia development could also contribute to ALL relapse.…”

“…Given that COVID-19 is a relatively new clinical entity, there are limited data as to whether SARS-CoV-2 infection affects incidence or outcome of leukemia. [10][11][12] We report 2 cases of patients with high-risk (HR) B-cell ALL (B-ALL) who developed isolated CNS relapses following confirmed SARS-CoV-2 infection, with a visual timeline of their clinical courses (Fig. 1).…”

Leukaemia and lockdown: The delayed infection model of childhood acute lymphoblastic leukaemia and the COVID‐19 pandemic

“…Following the publication of this case, a case of ALL was reported in a 9‐year‐old boy who had been exposed to COVID‐19 less than 4 weeks previously. 14 There was no clinical evidence of leukaemia in the patient when he was initially hospitalised with COVID‐19, and the full blood count was normal. However, 7 days after discharge he was reassessed for bone pain and anorexia, and near‐complete replacement of the bone marrow with lymphoblasts was discovered.…”

“…Following the publication of this case, a case of ALL was reported in a 9‐year‐old boy who had been exposed to COVID‐19 less than 4 weeks previously 14 . There was no clinical evidence of leukaemia in the patient when he was initially hospitalised with COVID‐19, and the full blood count was normal.…”