COVID‐19 outcomes in children, adolescents and young adults with cancer

Abstract

Pediatric oncology patients are at risk for poor outcomes with respiratory viral infections. Outcome data for COVID‐19 in children and young adults with cancer are needed; data are sparse for obese/overweight and adolescent and young adult subgroups. We conducted a single center cohort study of COVID‐19 outcomes in patients younger than 25 years with cancer. Candidate hospitalization risk factors were analyzed via univariable and multivariable analyses. Eighty‐seven patients with cancer and COVID‐19 were identified. Most were Hispanic/Latinx (n = 63, 72%). Forty‐two (48%) were overweight/obese. Anticancer therapy included chemotherapy only (n = 64, 74%), chimeric antigen receptor T‐cells (CAR‐T, n = 7), hematopoietic stem cell transplantation (HSCT, n = 12), or CAR‐T and HSCT (n = 4). There was no COVID‐19 related mortality. Twenty‐six patients (30%) required COVID‐19 related hospitalization; 4 required multiple hospitalizations. Nine (10%) had severe/critical infection; 6 needed intensive care. COVID‐19 resulted in anticancer therapy delays in 22 (34%) of 64 patients on active therapy (median delay = 14 days). Factors associated with hospitalization included steroids within 2 weeks prior to infection, lymphopenia, previous significant non‐COVID infection, and low COVID‐19 PCR cycle threshold value. CAR‐T recipients with B‐cell aplasia tended to have severe/critical infection (3 of 7 patients). A COVID‐19 antibody response was detected in 14 of 32 patients (44%). A substantial proportion of COVID‐19 infected children and young adults with cancer require inpatient management; morbidity may be high in B‐cell immunodeficiency. However, a majority of patients can be taken through chemotherapy without prolonged therapy delays. Viral load is a potential outcome predictor in COVID‐19 in pediatric cancer.

Older patients with COVID‐19 and neuropsychiatric conditions: A study of risk factors for mortality

“…Globally, data are sparse for patients with brain tumors and COVID‐19. A cohort of 87 patients under the age of 25 with cancer, including three patients with brain tumors showed no death related to COVID (Parker et al., 2022 ). Certain cohorts of older patients have found an association between cancer/malignity and death (Covino et al., 2021 ) while others have not (Genet et al., 2020 ; Li et al., 2020 ; Neumann‐Podczaska et al., 2020 ; Ramos‐Rincon et al., 2021 ; Vrillon et al., 2020 ; L. Wang et al., 2020 ; Zerah et al., 2021 ), but these studies did not mention brain tumors (Covino et al., 2021 ; Genet et al., 2020 ; Li et al., 2020 ; Neumann‐Podczaska et al., 2020 ; Ramos‐Rincon et al., 2021 ; Vrillon et al., 2020 ; L. Wang et al., 2020 ; Zerah et al., 2021 ).…”

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

“…It is crucial to keep in mind that these patients exhibit a reduced immune response to the vaccine; therefore, surveillance should continue [17] because viral load is a potential predictor of outcome [18].…”

Evaluation of the safety profile and therapeutic efficacy of remdesivir in children with SARS- CoV-2 infection – a single-centre, retrospective, cohort study

“…Although differences in immune response contribute to a usually less complicated course of the disease in children than in adults, this does not mean that in children severe courses do not occur. In addition, there are groups at increased risk of severe COVID-19, which include, among others, children with immunode ciencies [9][10][11]. They need both a safe and effective method of COVID-19 treatment, as well as prophylaxis of SARS-CoV-2 infection.…”