SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients. (December 2021)

• Record Type: Journal Article
• Authors: Haeusler, Gabrielle M.; Ammann, Roland A.; Carlesse, Fabianne; Groll, Andreas H.; Averbuch, Dina; Castagnola, Elio; Agyeman, Philipp K.A.; Phillips, Bob; Gilli, Flávio; Solopova, Galina; Attarbaschi, Andishe; Wegehaupt, Oliver; Speckmann, Carsten; Sung, Lillian; Lehrnbecher, Thomas
• Is Part Of: European journal of cancer. Volume 159(2021)
• Page Start: 78
• Page End: 86
• Publication Date: 2021-12
• Subjects: Child -- Cancer -- SARS-CoV-2 -- COVID-19 -- Chemotherapy -- Haematopoietic stem cell transplantation; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2021.09.027
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Purpose: There are limited data on SARS-CoV-2 (COVID-19) infection in children with cancer or after haematopoietic stem cell transplant (HSCT). We describe the severity and outcomes of SARS-COV-2 in these patients and identify factors associated with severe disease. Methods: This was a multinational, observational study of children (aged <19 years) with cancer or HSCT and SARS-CoV-2 confirmed by polymerase chain reaction. COVID-19 was classified as asymptomatic, mild, moderate, severe or critical (≥1 organ support). Exact polytomous regression was used to determine the relationship between clinical variables and disease severity. Results: One hundred and thirty-one patients with COVID-19 across 10 countries were identified (median age 8 years). Seventy-eight (60%) had leukaemia/lymphoma, 48 (37%) had solid tumour and five had primary immunodeficiency and HSCT. Fever (71%), cough (47%) and coryza (29%) were the most frequent symptoms. The median duration of detectable virus was 16 days (range, 1–79 days). Forty-nine patients (37%) were hospitalised for COVID-19 symptoms, and 15 (11%) required intensive care unit–level care. Chemotherapy was delayed/modified in 35% of patients. COVID-19 was asymptomatic in 32% of patients, mild in 47%, moderate in 8%, severe in 4% and critical in 9%. In 124 patients (95%), a full recovery was documented, and four (3%) died due to COVID-19. Any comorbidity (odds ratio, 2.94; 95% confidence interval [CI], 1.81–5.21), any coinfection (1.74; 95% CI 1.03–3.03) and severe baseline neutropenia (1.82; 95% CI 1.13–3.09) were independently and significantly associated with increasing disease severity. Conclusion: Although most children with cancer had asymptomatic/mild disease, 13% had severe COVID-19 and 3% died. Comorbidity, coinfection and neutropenia may increase the risk of severe disease. Our data may help management decisions in this vulnerable population. Highlights: Data on COVID-19 infection in children with cancer are limited. In this multinational study, 11% of children with cancer and COVID-19 required intensive care unit admission. There were 4 of 131 children who died due to infection. The median duration of detectable SARS-CoV-2 virus was 16 days. Comorbidity, coinfection and neutropenia were significantly associated with severe COVID-19.