COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

Abstract

Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently constitutes the leading and overwhelming health issue worldwide. In comparison with adults, children present milder symptoms, with most having an asymptomatic course. We hypothesized that COVID-19 infection has a negative impact on the continuation of chemotherapy and increases nonrelapse mortality. Material and methods This study was performed to assess the course of SARS-CoV-2 among children with hematological or oncological malignancies and its impact on cancer therapy. Records of SARS-CoV-2 infection in 155 children with malignancies from 14 Polish centers for pediatric hematology and oncology were collected and analyzed. Results SARS-CoV-2 replication was observed in 155 patients. Forty-nine patients were symptomatic, with the following being the most common manifestations: fever (31 patients), gastrointestinal symptoms (10), coryza (13), cough (13) and headache (8). In children who were retested, the median time of a positive PCR result was 16 days (range 1–70 days), but 12.7% of patients were positive beyond day + 20. The length of viral PCR positivity correlated with the absolute neutrophil count at diagnosis. Seventy-six patients did not undergo further SARS-CoV-2 testing and were considered convalescents after completion of isolation. Antibiotic therapy was administered in 15 children, remdesivir in 6, convalescent plasma in 4, oxygen therapy in 3 (1—mechanical ventilation), steroids in 2, intravenous immunoglobulins in 2, and heparin in 4. Eighty patients were treated with chemotherapy within 30 days after SARS-CoV-2 infection diagnosis or were diagnosed with SARS-CoV-2 infection during 30 days of chemotherapy administration. Respiratory symptoms associated with COVID-19 and associated with oxygen therapy were present in 4 patients in the study population, and four deaths were recorded (2 due to COVID-19 and 2 due to progressive malignancy). The probability of 100-day overall survival was 97.3% (95% CI 92.9–99%). Delay in the next chemotherapy cycle occurred in 91 of 156 cases, with a median of 14 days (range 2–105 days). Conclusions For the majority of pediatric cancer patients, SARS-CoV-2 infection does not result in a severe, life-threatening course. Our data show that interruptions in therapy are common and can result in suboptimal therapy.

Evaluation of Clinical Findings and Treatment Results of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Center Experience

“…Although different results can be observed when COVID-19 patients are evaluated in terms of gender, male predominance is mostly determined in pediatric and adult studies (11,(16)(17)(18). Similar results are obtained in pediatric cancer patients (3,14,19). Similar to the literature, the male/female ratio was 1.6 in our study.…”

“…While the first symptoms of pediatric patients at the time of admission were cough and fever, similar results were obtained in studies with cancer patients ( 3 , 14 , 16 , 19 ). In the study of Dong et al cough was the most common symptom with 48.5%, followed by fever with 41.5% ( 17 ).…”

Current attitude to deferral of cellular therapy or nontransplant chemotherapy due to SARS‐CoV‐2 asymptomatic infection: Survey of Infectious Diseases Working Party EBMT

“…Testing serves to inform decisions on timing of treatment and isolation precautions, so the fact that screening is performed does not necessarily mean that test results are used automatically in all patients. The results of this survey cannot be regarded that a standard practice is to defer therapy if testing is positive in asymptomatic patients, but in reality, the decision‐making is more individualized, as reported previously 4,5 …”

“…Such approach is strongly recommended by European Conference on Infections in Leukemia (ECIL‐4 and ECIL‐8) for patients with Community‐Acquired Respiratory Virus (CARV) symptomatic respiratory tract infectious disease (RTID) planned for allogeneic HCT. It should also be generally considered for patients with CARV RTID scheduled for chemotherapy of hematological diseases 4 . While this recommendation is widely accepted and evidence‐based with regard to symptomatic patients, the situation is much less clear for patients with asymptomatic infection.…”

“…It should also be generally considered for patients with CARV RTID scheduled for chemotherapy of hematological diseases. 4 While this recommendation is widely accepted and evidence-based with regard to symptomatic patients, the situation is much less clear for patients with asymptomatic infection.…”