Clinical profile and outcomes of COVID-19 infection during the first wave in children with hematological illnesses and cancer

Abstract

Background: Patients with cancer are at a higher risk of getting infected with the severe acute respiratory syndrome coronavirus 2 owing to their immunocompromised state. Providing care to these patients amidst the first wave of the coronavirus disease-2019 (COVID-19) pandemic was extremely challenging. Objectives: This study was aimed at evaluating the clinical profile and disease-related outcomes of pediatric patients with hematological illnesses and cancer. Materials and Methods: This retrospective study was conducted at a tertiary care center in North India during the first wave of the pandemic from March 2020 to December 2020. Children aged up to 18 years, who were treated for a hematological illness or malignancy or underwent hematopoietic stem cell transplantation (HSCT) and tested positive for COVID-19 regardless of symptoms were included in the study. Baseline demographic data related to the age, diagnosis, treatment status, and chemotherapy protocol used were collected. Outcomes including the cure rates, comorbidities, and sequelae were recorded. Results: A total of 650 tests for COVID-19 were performed for 181 children; 22 patients were found to be COVID-19 positive. The most common diagnosis was acute leukemia (63.6%). None of the patients developed COVID-19 pneumonia. The majority of patients had asymptomatic infection and were managed at home. Among those with a symptomatic infection, the most common symptoms were fever and cough. A total of 3 (13.6%) patients needed oxygen therapy, one developed multisystem inflammatory syndrome of children leading to cardiogenic shock. Three patients required intensive care or respiratory support; all the patients had favorable clinical outcomes. The median time from the onset of COVID-19 to a negative result on the reverse transcription-polymerase chain reaction test was 21.3 days. Cancer treatment was modified in 15 patients (68.2%). Conclusions: Our results suggest that children with hemato-oncological illnesses rarely experience severe COVID-19 disease. The impact of the first wave of COVID-19 primarily manifested as disruptions in the logistic planning and administration of essential treatment to these children rather than COVID-19 sequelae.

SARS-CoV-2 Infection in Children with Cancer: Experience from a Tertiary Care Center in North India

“…Selected studies on the clinical profile and outcome of SARS-CoV-2 infection in children with cancer are summarized in ►Table 5. 11, [13][14][15][16][17][18][19][20][21] In our cohort, a substantial proportion of admitted patients had cytopenias. However, as most had active hematological malignancy or recent exposure to myelosuppressive chemotherapy, the precise contribution of COVID-19 to the causation of cytopenia is elusive.…”

“…A relatively higher frequency (12.1% in the first wave and 17.4% in the second wave) of test positivity among pediatric oncology patients is reported from another center in North India. 13 A report of a single-center experience from South India documented a remarkably high rate (54%) of SARS-CoV-2 -positivity among children and young adolescents with cancer. 14 However, this study had a questionnaire-based A large fraction of children with SARS-CoV-2 infection were asymptomatic (48.5%) or mild-to-moderately symptomatic (42.5%).…”