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Velasco Puyó P, Tagarro A, Garcia-Obregon S, Villate Bejarano O, Moraleda C, Huerta Aragonés J, Bardón Cancho EJ, Faura Morros A, Galán-Gómez V, Escobar Fernández L, Lendinez-Molinos F, Herrero Velasco B, Ureña Horno L, Domínguez-Pinilla N, Pascual Gazquez JF, Nova Lozano C, Osuna-Marco M, Marín-Cruz I, Gomez Pastrana I, Garcia de Andoin Barandiaran N, Gallego Mingo N, Portugal Rodríguez R, Cañete A, Pareja León M, Castrillo Bustamante S, Tallón García M, Gónzalez-Prieto A, Solé-Rodríguez M, González Cruz M, Soriano-Arandes A, Mota M, Pérez-Hoyos S, Moreno L, Astigarraga I. Cancer is not a risk factor for severe COVID-19 in children, except in patients with recent allogeneic hematopoietic stem cell transplantation or comorbidities. Pediatr Blood Cancer 2024:e31120. [PMID: 38825724 DOI: 10.1002/pbc.31120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
The EPICO (Spanish general registry of COVID-19 in children)-SEHOP (Spanish Society of Pediatric Hematology and Oncology) platform gathers data from children with SARS-CoV-2 in Spain, allowing comparison between children with cancer or allogeneic hematopoietic stem cell transplantation (alloHSCT) and those without. The infection is milder in the cancer/alloHSCT group than in children without comorbidities (7.1% vs. 14.7%), except in children with recent alloHSCT (less than 300 days), of which 35.7% experienced severe COVID-19. These data have been shared with the SEHOP members to support treatment and isolation policies akin to those for children without cancer, except for those with recent alloHSCT or additional comorbidities. This highlights the collaborative registries potential in managing pandemic emergencies.
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Affiliation(s)
- Pablo Velasco Puyó
- Pediatric Oncology and Hematology Department, Vall d'Hebron Barcelona Hospital, Barcelona, Spain
| | - Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Department of Pediatrics, Infanta Sofía University Hospital, Fundación para la Investigación Biomédica e Innovación Hospital Universitario Infanta Sofía y Hospital del Henares (FIIB HUIS HHEN), Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Susana Garcia-Obregon
- BioBizkaia Health Research Institute, Pediatric Oncology Group, Barakaldo, Spain
- UPV/EHU, Physiology Department, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, Spain
| | | | - Cinta Moraleda
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Huerta Aragonés
- Paediatrics Department, Paediatric and Adolescent Haematology and Oncology Section, Hospital Materno-Infantil del Complejo Hospitalario General Universitario Gregorio Marañón, Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Eduardo J Bardón Cancho
- Paediatrics Department, Paediatric and Adolescent Haematology and Oncology Section, Hospital Materno-Infantil del Complejo Hospitalario General Universitario Gregorio Marañón, Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Anna Faura Morros
- Pediatric Oncology and Hematology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Víctor Galán-Gómez
- Pediatric Oncology and Hematology Department, Hospital Infantil Universitario La Paz, Madrid, Spain
| | - Laura Escobar Fernández
- Pediatric Oncology and Hematology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Blanca Herrero Velasco
- Pediatric Oncology and Hematology Unit, Hospital Infantil Universitario del Niño Jesús, Madrid, Spain
| | | | - Nerea Domínguez-Pinilla
- Pediatric Oncology Unit, Complejo Hospitalario de Toledo, Toledo, Spain
- i+12 Research Institute, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | - Inés Marín-Cruz
- Paediatric Infectious Diseases, Rheumatology and Immunology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Congenital Alterations of Immunity Group, Infectious Diseases and Immune System Area, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Irene Gomez Pastrana
- Pediatric Infectious Disease Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Nagore Garcia de Andoin Barandiaran
- Pediatric Oncology and Hematology Unit, Donostia University Hospital, San Sebastián, Spain
- Biogipuzkoa Health Research Institute, Pediatric Group, Paseo Dr. Begiristain, San Sebastián, Spain
- UPV/EHU, Pediatric Department, Paseo Dr. J. Beguiristain, Universidad del País Vasco/Euskal Herriko Unibertsitatea, San Sebastian, Spain
| | | | | | - Adela Cañete
- Pediatric Oncology and Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Pareja León
- Paediatrics Department, Hospital General de Albacete, Albacete, Spain
| | | | | | - Almudena Gónzalez-Prieto
- Pediatric Oncology and Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Antonio Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Miriam Mota
- Unit of Statistics and Bioinformatics (UEB), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Unit of Statistics and Bioinformatics (UEB), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Lucas Moreno
- Pediatric Oncology and Hematology Department, Vall d'Hebron Barcelona Hospital, Barcelona, Spain
| | - Itziar Astigarraga
- BioBizkaia Health Research Institute, Pediatric Oncology Group, Barakaldo, Spain
- Department of Pediatrics, Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Department of Pediatrics, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Spain
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Bozkurt C, Hazar V, Malbora B, Küpesiz A, Aygüneş U, Fışgın T, Karakükçü M, Kuşkonmaz B, Kılıç SÇ, Bayırlı D, Arman Bilir Ö, Yalçın K, Gözmen S, Uygun V, Elli M, Sarbay H, Küpesiz FT, Şaşmaz Hİ, Aksoy BA, Yılmaz E, Okur FV, Tekkeşin F, Yenigürbüz FD, Özek G, Atay AA, Bozkaya İO, Çelen S, Öztürkmen S, Güneş AM, Gürsel O, Güler E, Özcan A, Çetinkaya DU, Aydoğdu S, Özbek NY, Karasu G, Sezgin G, Doğru Ö, Albayrak D, Öztürk G, Aksoylar S, Daloğlu H, Odaman Al I, Evim MS, Akbayram S, Öncül Y, Zengin E, Albayrak C, Timur Ç, Kar YD, Çakmaklı HF, Tüfekçi Ö, Töret E, Antmen B. COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group. Pediatr Transplant 2024; 28:e14758. [PMID: 38659218 DOI: 10.1111/petr.14758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 02/27/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. OBJECTIVES The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. METHOD In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. RESULTS The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. CONCLUSION While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.
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Affiliation(s)
- Ceyhun Bozkurt
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Istinye University School of Medicine, Bahçelievler Medicalpark Hospital, Istanbul, Turkey
| | - Volkan Hazar
- Department of Pediatric Hematology-Oncology, Memorial Health Group, Medstar Yıldız Hospital, Antalya, Turkey
| | - Barış Malbora
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Utku Aygüneş
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
| | - Tunç Fışgın
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Bahçelievler Medicalpark Hospital, Altınbaş University School of Medicine, Istanbul, Turkey
| | - Musa Karakükçü
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Barış Kuşkonmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Suar Çakı Kılıç
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Derya Bayırlı
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Özlem Arman Bilir
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Koray Yalçın
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Salih Gözmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Behçet Uz Training and Research Hospital, Izmir, Turkey
| | - Vedat Uygun
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Murat Elli
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medipol University School of Medicine, Istanbul, Turkey
| | - Hakan Sarbay
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Funda Tayfun Küpesiz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hatice İlgen Şaşmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
| | - Başak Adaklı Aksoy
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Bahçelievler Medicalpark Hospital, Altınbaş University School of Medicine, Istanbul, Turkey
| | - Ebru Yılmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Fatma Visal Okur
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Funda Tekkeşin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Demir Yenigürbüz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Gülcihan Özek
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ege University School of Medicine, İzmir, Turkey
| | - Abdullah Avni Atay
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Suna Çelen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Seda Öztürkmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Adalet Meral Güneş
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Uludağ University School of Medicine, Bursa, Turkey
| | - Orhan Gürsel
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Elif Güler
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Alper Özcan
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Duygu Uçkan Çetinkaya
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Selime Aydoğdu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Gülsün Karasu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Gülay Sezgin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Çukurova University School of Medicine, Adana, Turkey
| | - Ömer Doğru
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Marmara University School of Medicine, Istanbul, Turkey
| | - Davut Albayrak
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Samsun Hospital, Samsun, Turkey
| | - Gülyüz Öztürk
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Serap Aksoylar
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ege University School of Medicine, İzmir, Turkey
| | - Hayriye Daloğlu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Işık Odaman Al
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medipol University School of Medicine, Istanbul, Turkey
| | - Melike Sezgin Evim
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Uludağ University School of Medicine, Bursa, Turkey
| | - Sinan Akbayram
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Yurday Öncül
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Inönü University School of Medicine, Malatya, Turkey
| | - Emine Zengin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Canan Albayrak
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Çetin Timur
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Yeter Düzenli Kar
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Hasan Fatih Çakmaklı
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Tüfekçi
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ersin Töret
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Bülent Antmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
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Nawi MA, Lau SCD, Chin ST, Teh KH, Ho LSB, Alias H. Caring for a child with cancer during COVID-19 pandemic: an assessment of the parents' perception and stress level. Front Public Health 2024; 12:1223362. [PMID: 38655523 PMCID: PMC11036860 DOI: 10.3389/fpubh.2024.1223362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Background The emergence of COVID-19 pandemic has led to heightened fear and uncertainty among parents of children with cancer. This study was conducted to evaluate the parental perceptions toward effects of COVID-19 infection to children with cancer, determine their stress level and factors contributing to high stress level during the pandemic. Methods This cross-sectional study was conducted in three paediatric oncology centres in Malaysia from September 2020 until December 2022. A total of 167 parents were recruited. Parents completed a set of questionnaires to assess their perception on effect of COVID-19 infection to children with cancer and COVID Stress Scale (CSS) to assess the parents' stress level. Results Patients' mean age at study entry was 8.75 years (SD 4.38). Ninety-one (54.5%) patients were still on active treatment. More than 80% of the parents obtained information regarding COVID-19 infection from mass media and social networking. Fear of their children contracting COVID-19 infection was high especially among patients who were still on treatment. Forty-nine (29.3%) parents were significantly affected by the pandemic leading to loss of job or monthly income. Twenty-nine (17.4%) patients required treatment modification during the pandemic. The median total score for CSS was 78.0 (IQR 25th 64.0; 75th 95.0). Ninety-one (54.5%) respondents were very/extremely stressed based on the CSS scores. Components with high scores were xenophobia (median score 18.0; IQR 25th 13.0, 75th 22.0), fear of danger (median score 17.0; IQR 25th 14.0, 75th 20.0) and contamination fears (median score 16.0; IQR 25th 12.0, 75th 19.0). Lower household income was associated with higher stress level (p = 0.006). Conclusion Our study demonstrated high awareness regarding risk of COVID-19 infection among parents of oncology children. Half of the parents had high stress level, with low household income identified as a factor associated with high stress level.
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Affiliation(s)
- Muhamad Aizat Nawi
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Sie Chong Doris Lau
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shi Tying Chin
- Department of Paediatrics, Sarawak General Hospital, Kuching, Malaysia
| | - Kok Hoi Teh
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Lee Sue Betty Ho
- Department of Paediatrics, Sarawak General Hospital, Kuching, Malaysia
| | - Hamidah Alias
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Kamal M, Baudo M, Joseph J, Geng Y, Mohamed O, Rahouma M, Greenbaum U. Characteristics and Outcomes of Stem Cell Transplant Patients during the COVID-19 Era: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:530. [PMID: 38470640 PMCID: PMC10931059 DOI: 10.3390/healthcare12050530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
This systematic review and meta-analysis aims to identify the outcomes of stem cell transplant (SCT) patients during the COVID-19 era. Pooled event rates (PER) were calculated, and meta-regression was performed. A random effects model was utilized. In total, 36 eligible studies were included out of 290. The PER of COVID-19-related deaths and COVID-19-related hospital admissions were 21.1% and 55.2%, respectively. The PER of the use of hydroxychloroquine was 53.27%, of the receipt of immunosuppression it was 39.4%, and of the use of antivirals, antibiotics, and steroids it was 71.61%, 37.94%, and 18.46%, respectively. The PER of the time elapsed until COVID-19 infection after SCT of more than 6 months was 85.3%. The PER of fever, respiratory symptoms, and gastrointestinal symptoms were 70.9, 76.1, and 19.3%, respectively. The PER of acute and chronic GvHD were 40.2% and 60.9%, respectively. SCT patients are at a higher risk of severe COVID-19 infection and mortality. The use of dexamethasone improves the survival of hospitalized SCT patients with moderate to severe COVID-19 requiring supplemental oxygen or ventilation. The SCT patient group is a heterogeneous group with varying characteristics. The quality of reporting on these patients when infected with COVID-19 is not uniform and further prospective or registry studies are needed to better guide clinical care in this unique setting.
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Affiliation(s)
- Mona Kamal
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Massimo Baudo
- Department of Cardiac Surgery, Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Jacinth Joseph
- Hematology and Medical Oncology, University of Pittsburg Medical Center-Hillman Cancer Center, Altoona, PA 16601, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Omnia Mohamed
- Department of Medical Oncology, NCI, Cairo 11796, Egypt;
| | - Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo 12613, Egypt;
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Uri Greenbaum
- Department of Hematology, Soroka University Medical Center, Beer Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel
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Greenan-Barrett J, Aston S, Deakin CT, Ciurtin C. The impact of immunocompromise on outcomes of COVID-19 in children and young people-a systematic review and meta-analysis. Front Immunol 2023; 14:1159269. [PMID: 37691952 PMCID: PMC10485615 DOI: 10.3389/fimmu.2023.1159269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
Background Despite children and young people (CYP) having a low risk for severe coronavirus disease 2019 (COVID-19) outcomes, there is still a degree of uncertainty related to their risk in the context of immunodeficiency or immunosuppression, primarily due to significant reporting bias in most studies, as CYP characteristically experience milder or asymptomatic COVID-19 infection and the severe outcomes tend to be overestimated. Methods A comprehensive systematic review to identify globally relevant studies in immunosuppressed CYP and CYP in general population (defined as younger than 25 years of age) up to 31 October 2021 (to exclude vaccinated populations) was performed. Studies were included if they reported the two primary outcomes of our study, admission to intensive therapy unit (ITU) and mortality, while data on other outcomes, such as hospitalization and need for mechanical ventilation were also collected. A meta-analysis estimated the pooled proportion for each severe COVID-19 outcome, using the inverse variance method. Random effects models were used to account for interstudy heterogeneity. Findings The systematic review identified 30 eligible studies for each of the two populations investigated: immunosuppressed CYP (n = 793) and CYP in general population (n = 102,022). Our meta-analysis found higher estimated prevalence for hospitalization (46% vs. 16%), ITU admission (12% vs. 2%), mechanical ventilation (8% vs. 1%), and increased mortality due to severe COVID-19 infection (6.5% vs. 0.2%) in immunocompromised CYP compared with CYP in general population. This shows an overall trend for more severe outcomes of COVID-19 infection in immunocompromised CYP, similar to adult studies. Interpretation This is the only up-to-date meta-analysis in immunocompromised CYP with high global relevance, which excluded reports from hospitalized cohorts alone and included 35% studies from low- and middle-income countries. Future research is required to characterize individual subgroups of immunocompromised patients, as well as impact of vaccination on severe COVID-19 outcomes. Systematic Review Registration PROSPERO identifier, CRD42021278598.
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Affiliation(s)
- James Greenan-Barrett
- Department of Adolescent Rheumatology, University College London Hospital (UCLH), London, United Kingdom
| | - Samuel Aston
- Medical School, University College London (UCL), London, United Kingdom
| | - Claire T Deakin
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and Great Ormond Street (GOS) Hospital (GOSH), London, United Kingdom
- UCL GOS Institute of Child Health, UCL, London, United Kingdom
- Department of Paediatric Rheumatology GOSH, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and Great Ormond Street (GOS) Hospital (GOSH), London, United Kingdom
- National Institute of Health Research - Biomedical Research Centre, UCLH, London, United Kingdom
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Schmidt KLJ, Dautzenberg NMM, Hoogerbrugge PM, Lindemans CA, Nierkens S, Smits G, Van Binnendijk RS, Bont LJ, Tissing WJE. Immune Response following BNT162b2 mRNA COVID-19 Vaccination in Pediatric Cancer Patients. Cancers (Basel) 2023; 15:cancers15092562. [PMID: 37174028 PMCID: PMC10177402 DOI: 10.3390/cancers15092562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
COVID-19 vaccinations are recommended for children with cancer but data on their vaccination response is scarce. This study assesses the antibody and T-cell response following a 2- or 3-dose vaccination with BNT162b2 mRNA COVID-19 vaccine in children (5-17 years) with cancer. For the antibody response, participants with a serum concentration of anti-SARS-CoV-2 spike 1 antibodies of >300 binding antibody units per milliliter were classified as good responders. For the T-cell response, categorization was based on spike S1 specific interferon-gamma release with good responders having >200 milli-international units per milliliter. The patients were categorized as being treated with chemo/immunotherapy for less than 6 weeks (Tx < 6 weeks) or more than 6 weeks (Tx > 6 weeks) before the first immunization event. In 46 patients given a 2-dose vaccination series, the percentage of good antibody and good T-cell responders was 39.3% and 73.7% in patients with Tx < 6 weeks and 94.4% and 100% in patients with Tx > 6 weeks, respectively. An additional 3rd vaccination in 16 patients with Tx < 6 weeks, increased the percentage of good antibody responders to 70% with no change in T-cell response. A 3-dose vaccination series effectively boosted antibody levels and is of value for patients undergoing active cancer treatment.
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Affiliation(s)
- K L Juliëtte Schmidt
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Noël M M Dautzenberg
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Peter M Hoogerbrugge
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Caroline A Lindemans
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Stefan Nierkens
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Gaby Smits
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Rob S Van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Louis J Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
- Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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7
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Balakumar N, Catueno S, Nadiger M, Keshavamurthy PRS, Totapally BR, Sherani F, Mba N, Gist KM, Tripathi S, Gajic O, Deo N, Kumar V, Walkey A, Kashyap R, Bhalala US. Coronavirus Disease 2019 in Pediatric Oncology Patients: A Matched-Cohort Analysis of the SCCM Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 Registry. J Pediatr Hematol Oncol 2023; 45:e309-e314. [PMID: 36729758 PMCID: PMC10038816 DOI: 10.1097/mph.0000000000002588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is a paucity of multicenter data describing the impact of coronavirus disease 2019 (COVID-19) on hospitalized pediatric oncology patients. Using a large, multicenter, Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness University Study (VIRUS) database, we aimed at assessing outcomes of COVID-19 infection in this population. METHOD This is a matched-cohort study involving children below 18 years of age hospitalized with COVID-19 between March 2020 and January 2021. Using the VIRUS; COVID-19 Registry database, children with oncologic diseases were compared with propensity score matched (age groups, sex, race, and ethnicity) cohort of children without oncologic diseases for the prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C), intensive care unit (ICU) admission, interventions, hospital, and ICU length of stay. RESULTS The number of children in the case and control groups was 45 and 180, respectively. ICU admission rate was similar in both groups ([47.7 vs 51.7%], P =0.63). The proportion of children requiring noninvasive and invasive mechanical ventilation, and its duration were similar between groups, same as hospital mortality. Interestingly, MIS-C was significantly lower in the oncology group compared with the control (2.4 vs 24.6%; P =0.0002). CONCLUSIONS In this study using a multicenter VIRUS database, ICU admission rate, interventions, and outcomes of COVID-19 were similar in children with the oncologic disease compared with control patients. The incidence of MIS-C is lower in oncologic patients.
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Affiliation(s)
- Niveditha Balakumar
- Division of Critical Care Medicine, Department of Pediatrics, Children’s Hospital of San Antonio and Baylor College of Medicine, Houston
| | - Samanta Catueno
- Department of Pediatrics, Driscoll Children’s Hospital, Corpus Christi, TX and Texas A&M University, College Station, TX
| | - Meghana Nadiger
- Division of Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Illinois and University of Illinois College of Medicine
| | - Prithvi Raj Sendi Keshavamurthy
- Division of Critical Care Medicine, Department of Pediatrics, Nicklaus Children’s Hospital and Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Balagangadhar R Totapally
- Division of Critical Care Medicine, Department of Pediatrics, Nicklaus Children’s Hospital and Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Farha Sherani
- Division of Hematology-Oncology, Department of Pediatrics, Driscoll Children’s Hospital, Corpus Christi and Texas A and M University, College Station
| | - Nkechi Mba
- Division of Hematology-Oncology, Department of Pediatrics, Driscoll Children’s Hospital, Corpus Christi and Texas A and M University, College Station
| | | | | | | | | | | | | | | | - Utpal S. Bhalala
- Department of Pediatrics, Driscoll Children’s Hospital, Corpus Christi, TX and Texas A&M University, College Station, TX
- Department of Anesthesiology and Critical Care, University of Texas Medical Branch, Galveston, TX
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8
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Risk factors for a severe disease course in children with SARS-COV-2 infection following hematopoietic cell transplantation in the pre-Omicron period: a prospective multinational Infectious Disease Working Party from the European Society for Blood and Marrow Transplantation group (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH) study. Bone Marrow Transplant 2023; 58:558-566. [PMID: 36849806 PMCID: PMC9969031 DOI: 10.1038/s41409-023-01941-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/28/2023]
Abstract
Risk factors for severe SARS-Cov-2 infection course are poorly described in children following hematopoietic cell transplantation (HCT). In this international study, we analyzed factors associated with a severe course (intensive care unit (ICU) admission and/or mortality) in post-HCT children. Eighty-nine children (58% male; median age 9 years (min-max 1-18)) who received an allogeneic (85; 96%) or an autologous (4; 4%) HCT were reported from 28 centers (18 countries). Median time from HCT to SARS-Cov-2 infection was 7 months (min-max 0-181). The most common clinical manifestations included fever (37; 42%) and cough (26; 29%); 37 (42%) were asymptomatic. Nine (10%) children following allo-HCT required ICU care. Seven children (8%) following allo-HCT, died at a median of 22 days after SARS-Cov-2 diagnosis. In a univariate analysis, the probability of a severe disease course was higher in allo-HCT children with chronic GVHD, non-malignant disease, immune suppressive treatment (specifically, mycophenolate), moderate immunodeficiency score, low Lansky score, fever, cough, coinfection, pulmonary radiological findings, and high C-reactive protein. In conclusion, SARS-Cov-2 infection in children following HCT was frequently asymptomatic. Despite this, 10% needed ICU admission and 8% died in our cohort. Certain HCT, underlying disease, and SARS-Cov-2 related factors were associated with a severe disease course.
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9
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Koo J, Auletta JJ, Hartley DM, Huber J, Jaglowski S, Kapadia M, Kusnier K, Lehmann L, Maakaron J, Myers KC, Pai A, Parker L, Phelan R, Sper C, Rotz SJ, Dandoy CE. Secondary Impact of the Coronavirus Disease 19 Pandemic on Patients and the Cellular Therapy Healthcare Ecosystem. Transplant Cell Ther 2022; 28:737-746. [PMID: 35902050 PMCID: PMC9313529 DOI: 10.1016/j.jtct.2022.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has significantly impacted global health and healthcare delivery systems. To characterize the secondary effects of the COVID-19 pandemic and mitigation strategies used in the delivery of hematopoietic stem cell transplantation (HSCT) care, we performed a comprehensive literature search encompassing changes in specific donor collection, processing practices, patient outcomes, and patient-related concerns specific to HSCT and HSCT-related healthcare delivery. In this review, we summarize the available literature on the secondary impacts the COVID-19 pandemic on the fields of HSCT and cellular therapy. The COVID-19 pandemic has had numerous secondary impacts on patients undergoing HSCT and the healthcare delivery systems involved in providing complex care to HSCT recipients. Institutions must identify these influences on outcomes and adjust accordingly to maintain and improve outcomes for the transplantation and cellular therapy community.
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Affiliation(s)
- Jane Koo
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
| | - Jeffrey J Auletta
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin; Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - David M Hartley
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John Huber
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Samantha Jaglowski
- Division of Hematology-Oncology and Transplantation; Department of Pediatrics, Ohio State University Medical Center, Columbus, Ohio
| | - Malika Kapadia
- Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School, Boston, Massachusetts
| | - Katilyn Kusnier
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Leslie Lehmann
- Division of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Department of Pediatrics, Harvard University Medical School, Boston, Massachusetts
| | - Joseph Maakaron
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Ahna Pai
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Loretta Parker
- Division of Hematology/Oncology, Department of Pediatrics, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Rachel Phelan
- Division of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin
| | - Christine Sper
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
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10
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Lim YJ, Khan U, Karpha I, Ross A, Saif M, Remberger M, Kalakonda N, Pettitt AR, Floisand Y. COVID‐19 outcomes in haematopoietic cell transplant recipients: A systematic review and meta‐analysis. EJHAEM 2022; 3:862-872. [PMID: 35941880 PMCID: PMC9350043 DOI: 10.1002/jha2.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Up‐to‐date information on coronavirus disease 2019 (COVID‐19) outcomes and risk factors in haematopoietic cell transplantation (HCT) recipients is required to inform on decisions about cancer treatment and COVID‐19 mitigation strategies. We performed a meta‐analysis to address this knowledge gap. All studies with at least five patients who reported COVID‐19‐related deaths in HCT recipients were included. The primary outcome was COVID‐19‐related death. Secondary outcomes were COVID‐19‐related mechanical ventilation (MV) and intensive care unit (ITU) admission. The cumulative COVID‐19‐related death rate among HCT recipients was 21% (95% confidence interval [CI] 18%–24%), while MV and ITU admission rates were 14% (95% CI 11%–17%) and 18% (95% CI 14%–22%), respectively. Subgroup analysis showed higher death rates in patients who developed COVID‐19 within 12 months of HCT (risk ratio [RR] 1.82, 95% CI 1.09–3.03), within 6 months of receiving immunosuppressant drugs (RR 2.11, 95% CI 1.38–3.20) or in the context of active graft‐versus‐host disease (RR 2.38, 95% CI 1.10–5.16). Our findings support the idea that HCT should remain an integral part of cancer treatment during the COVID‐19 pandemic but also highlight the need to prioritise preventative measures in those patients who are at increased risk of adverse COVID‐19 outcomes.
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Affiliation(s)
- Yeong Jer Lim
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Umair Khan
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Indrani Karpha
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Andrew Ross
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
| | - Muhammad Saif
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
| | - Mats Remberger
- Department of Medical Sciences Uppsala University and KFUE Uppsala University Hospital Uppsala Sweden
| | - Nagesh Kalakonda
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Andrew R. Pettitt
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Institute of Systems, Molecular and Integrative Biology University of Liverpool Liverpool UK
| | - Yngvar Floisand
- Haemato‐oncology Department Clatterbridge Cancer Centre NHS Foundation Trust Liverpool UK
- Centre for Cancer Cell Reprogramming, Institute of Clinical Medicine University of Oslo Oslo Norway
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11
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Bhatt NS, Sharma A, St. Martin A, Abid MB, Brown VI, Diaz Perez MA, Frangoul H, Gadalla SM, Herr MM, Krem MM, Lazarus HM, Martens MJ, Mehta PA, Nishihori T, Prestidge T, Pulsipher MA, Rangarajan HG, Williams KM, Winestone LE, Yin DE, Riches ML, Dandoy CE, Auletta JJ. Clinical Characteristics and Outcomes of COVID-19 in Pediatric and Early Adolescent and Young Adult Hematopoietic Stem Cell Transplant Recipients: A Cohort Study. Transplant Cell Ther 2022; 28:696.e1-696.e7. [PMID: 35798233 PMCID: PMC9251957 DOI: 10.1016/j.jtct.2022.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/23/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Adult hematopoietic stem cell transplantation (HSCT) recipients are at a high risk of adverse outcomes after COVID-19. Although children have had better outcomes after COVID-19 compared to adults, data on risk factors and outcomes of COVID-19 among pediatric HSCT recipients are lacking. We describe outcomes of HSCT recipients who were ≤21 years of age at COVID-19 diagnosis and were reported to the Center for International Blood and Marrow Transplant Research between March 27, 2020, and May 7, 2021. The primary outcome was overall survival after COVID-19 diagnosis. We determined risk factors of COVID-19 as a secondary outcome in a subset of allogeneic HSCT recipients. A total of 167 pediatric HSCT recipients (135 allogeneic; 32 autologous HSCT recipients) were included. Median time from HSCT to COVID-19 was 15 months (interquartile range [IQR] 7-45) for allogeneic HSCT recipients and 16 months (IQR 6-59) for autologous HSCT recipients. Median follow-up from COVID-19 diagnosis was 53 days (range 1-270) and 37 days (1-179) for allogeneic and autologous HSCT recipients, respectively. Although COVID-19 was mild in 87% (n = 146/167), 10% (n = 16/167) of patients required supplemental oxygen or mechanical ventilation. The 45-day overall survival was 95% (95% confidence interval [CI], 90-99) and 90% (74-99) for allogeneic and autologous HSCT recipients, respectively. Cox regression analysis showed that patients with a hematopoietic cell transplant comorbidity index (HCT-CI) score of 1-2 were more likely to be diagnosed with COVID-19 (hazard ratio 1.95; 95% CI, 1.03-3.69, P = .042) compared to those with an HCT-CI of 0. Pediatric and early adolescent and young adult HSCT recipients with pre-HSCT comorbidities were more likely to be diagnosed with COVID-19. Overall mortality, albeit higher than the reported general population estimates, was lower when compared with previously published data focusing on adult HSCT recipients.
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12
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Wolf J, Abzug MJ, Anosike BI, Vora SB, Waghmare A, Sue PK, Olivero RM, Oliveira CR, James SH, Morton TH, Maron GM, Young JL, Orscheln RC, Schwenk HT, Bio LL, Willis ZI, Lloyd EC, Hersh AL, Huskins CW, Soma VL, Ratner AJ, Hayes M, Downes K, Chiotos K, Grapentine SP, Wattier RL, Lamb GS, Zachariah P, Nakamura MM. Updated Guidance on Use and Prioritization of Monoclonal Antibody Therapy for Treatment of COVID-19 in Adolescents. J Pediatric Infect Dis Soc 2022; 11:177-185. [PMID: 35107571 PMCID: PMC8903349 DOI: 10.1093/jpids/piab124] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Starting in November 2020, the US Food and Drug Administration (FDA) has issued Emergency Use Authorizations (EUAs) for multiple novel virus-neutralizing monoclonal antibody therapies, including bamlanivimab monotherapy (now revoked), bamlanivimab and etesivimab, casirivimab and imdevimab (REGEN-COV), and sotrovimab, for treatment or postexposure prophylaxis of Coronavirus disease 2019 (COVID-19) in adolescents (≥12 years of age) and adults with certain high-risk conditions. Previous guidance is now updated based on new evidence and clinical experience. METHODS A panel of experts in pediatric infectious diseases, pediatric infectious diseases pharmacotherapy, and pediatric critical care medicine from 18 geographically diverse US institutions was convened. Through a series of teleconferences and web-based surveys, a guidance statement was developed and refined based on a review of the best available evidence and expert opinion. RESULTS The course of COVID-19 in children and adolescents is typically mild, though more severe disease is occasionally observed. Evidence supporting risk stratification is incomplete. Randomized controlled trials have demonstrated the benefit of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-specific monoclonal antibody therapies in adults, but data on safety and efficacy in children or adolescents are limited. Potential harms associated with infusion reactions or anaphylaxis are reportedly low in adults. CONCLUSIONS Based on evidence available as of August 31, 2021, the panel suggests a risk-based approach to administration of SARS-CoV-2 monoclonal antibody therapy. Therapy is suggested for the treatment of mild to moderate COVID-19 in adolescents (≥12 years of age) at the highest risk of progression to hospitalization or severe disease. Therapeutic decision-making about those at moderate risk of severe disease should be individualized. Use as postexposure prophylaxis could be considered for those at the highest risk who have a high-risk exposure but are not yet diagnosed with COVID-19. Clinicians and health systems should ensure safe and timely implementation of these therapeutics that does not exacerbate existing healthcare disparities.
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Affiliation(s)
- Joshua Wolf
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Mark J Abzug
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Brenda I Anosike
- Department of Pediatrics, Children's Hospital at Montefiore, New York, New York, USA
| | - Surabhi B Vora
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Alpana Waghmare
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Paul K Sue
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rosemary M Olivero
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital of Spectrum Health, Michigan State College of Human Medicine, Grand Rapids, Michigan, USA
| | - Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott H James
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Theodore H Morton
- Department of Pharmacy, St Jude's Children's Research Hospital, Memphis, Tennessee, USA
| | - Gabriela M Maron
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jennifer L Young
- Department of Pharmacy, Washington University and St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Rachel C Orscheln
- Department of Pediatrics, Washington University and St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Hayden T Schwenk
- Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Stanford, California, USA
| | - Laura L Bio
- Department of Pharmacy, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Stanford, California, USA
| | - Zachary I Willis
- Department of Pediatrics, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth C Lloyd
- Department of Pediatrics, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Adam L Hersh
- Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Charles W Huskins
- Department of Pediatrics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Vijaya L Soma
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, New York, USA
| | - Adam J Ratner
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU Grossman School of Medicine, New York, New York, USA
| | - Molly Hayes
- Center for Healthcare Quality & Analytics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin Downes
- Department of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen Chiotos
- Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven P Grapentine
- Department of Pharmacy, University of California-San Francisco, San Francisco, California, USA
| | - Rachel L Wattier
- Department of Pediatrics, University of California-San Francisco, San Francisco, California, USA
| | - Gabriella S Lamb
- Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Philip Zachariah
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
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13
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Majeed A, Wright T, Guo B, Arora RS, Lam CG, Martiniuk AL. The Global Impact of COVID-19 on Childhood Cancer Outcomes and Care Delivery - A Systematic Review. Front Oncol 2022; 12:869752. [PMID: 35463381 PMCID: PMC9023072 DOI: 10.3389/fonc.2022.869752] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Childhood cancer represents a leading cause of death and disease burden in high income countries (HICs) and low-and-middle income countries (LMICs). It is postulated that the current COVID-19 pandemic has hampered global development of pediatric oncology care programs. This systematic review aimed to comprehensively review the global impact of COVID-19 on childhood cancer clinical outcomes and care delivery. Methods A systematic search was conducted on PubMed, Embase, Medline, and the African Medical Index from inception to November 3, 2021 following PRISMA guidelines. A manual search was performed to identify additional relevant studies. Articles were selected based on predetermined eligibility criteria. Findings The majority of studies reported patients with cancer and COVID-19 presenting as asymptomatic (HICs: 33.7%, LMICs: 22.0%) or with primary manifestations of fever (HICs: 36.1%, LMICs: 51.4%) and respiratory symptoms (HICs: 29.6%, LMICs: 11.7%). LMICs also reported a high frequency of patients presenting with cough (23.6%) and gastrointestinal symptoms (10.6%). The majority of patients were generally noted to have a good prognosis; however the crude mortality rate was higher in LMICs when compared to HICs (8.0% vs 1.8%). Moreover, the pandemic has resulted in delays and interruptions to cancer therapies and delays in childhood cancer diagnoses in both HICs and LMICs. However, these findings were disproportionately reported in LMICs, with significant staff shortages, supply chain disruptions, and limited access to cancer therapies for patients. Conclusions The COVID-19 pandemic has resulted in delays and interruptions to childhood cancer therapies and delays in childhood cancer diagnoses, and disproportionately so within LMICs. This review provides lessons learned for future system-wide disruptions to care, as well as provides key points for moving forward better with care through the remainder of this pandemic. Systematic Review Registration CRD42021266758, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=266758
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Affiliation(s)
- Amna Majeed
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tom Wright
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Biqi Guo
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Catherine G Lam
- Department of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Alexandra L Martiniuk
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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14
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Isolated CNS Relapse in 2 High-Risk B-cell Acute Lymphoblastic Leukemia Patients Following SARS-CoV-2 Infection. J Pediatr Hematol Oncol 2022; 44:e723-e727. [PMID: 34935738 DOI: 10.1097/mph.0000000000002377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
B-cell acute lymphoblastic leukemia (B-ALL) is the most common pediatric malignancy with a highly favorable overall prognosis. Central nervous system (CNS) relapse of B-ALL is relatively rare and is associated with inferior survival outcomes. We present two patients with B-ALL who developed isolated CNS relapse following confirmed infection with severe acute respiratory syndrome coronavirus 2. In addition to individual and disease factors, we posit that delays in therapy together with immune system modulation because of severe acute respiratory syndrome coronavirus 2 may account for these 2 cases of CNS relapsed B-ALL. We report on this clinical observation to raise awareness of this potential association.
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15
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AYGÜNEŞ U, KARAGÜN B, ŞAŞMAZ Hİ, AKBAŞ T, ANTMEN AB. Clinical and radiological features of COVID-19 infection in pediatric hematology-oncology and transplant patients. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1036774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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Kahn AR, Schwalm CM, Wolfson JA, Levine JM, Johnston EE. COVID-19 in Children with Cancer. Curr Oncol Rep 2022; 24:295-302. [PMID: 35113354 PMCID: PMC8811341 DOI: 10.1007/s11912-022-01207-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This study aims to describe what is currently known about how children with cancer have been affected by the COVID-19 pandemic, including morbidity and mortality, interruptions in cancer care and delays in diagnosis, and psychosocial effects. Here we summarize the literature on how this patient population has fared during the pandemic, reviewing multiple smaller reports along with two large registries. RECENT FINDINGS Although children with cancer generally have better outcomes with COVID-19 infection than adults with cancer, their risks of hospitalization, ICU admission, and death are greatly increased compared to the general pediatric population. There are socioeconomic and ethnic disparities present in these effects. Children with cancer experience significant risks from the COVID-19 pandemic. It has yet to be seen how delays and interruptions of cancer treatment and direct organ toxicities caused by the virus itself may affect long-term outcomes in these patients.
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Affiliation(s)
- Alissa R Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph's University Medical Center, 703 Main Street, Paterson, NJ, 07503, USA.
| | - Carla M Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, 601 John Street, Kalamazoo, MI, 49007, USA
| | - Julie Ann Wolfson
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue S, Lowder Suite 500, Birmingham, AL, USA
| | - Jennifer M Levine
- Pediatric Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, 525 East 68th St, Payson 6, New York, NY, 10024, USA
| | - Emily E Johnston
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue S, Lowder Suite 500, Birmingham, AL, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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17
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Millen GC, Arnold R, Cazier JB, Curley H, Feltbower R, Gamble A, Glaser A, Grundy RG, Kirton L, Lee LYW, McCabe MG, Palles C, Phillips B, Stiller CA, Varnai C, Kearns P. COVID-19 in children with haematological malignancies. Arch Dis Child 2022; 107:186-188. [PMID: 34301621 PMCID: PMC8785070 DOI: 10.1136/archdischild-2021-322062] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children with cancer are not at increased risk of severe SARS-CoV-2 infection; however, adults with haematological malignancies have increased risk of severe infections compared with non-haematological malignancies. METHODS We compared patients with haematological and non-haematological malignancies enrolled in the UK Paediatric Coronavirus Cancer Monitoring Project between 12 March 2020 and 16 February 2021. Children who received stem cell transplantation were excluded. RESULTS Only 2/62 patients with haematological malignancy had severe/critical infections, with an OR of 0.5 for patients with haematological compared with non-haematological malignancies. INTERPRETATION Children with haematological malignancies are at no greater risk of severe SARS-CoV-2 infection than those with non-haematological malignancies.
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Affiliation(s)
- Gerard Cathal Millen
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Helen Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard Feltbower
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
| | - Ashley Gamble
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Adam Glaser
- Leeds Institute for Data Analytics (LIDA), University of Leeds School of Medicine, Leeds, West Yorkshire, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Richard G Grundy
- CCLG Executive, Children's Cancer and Leukaemia Group, Leicester, UK
- School of Medicine, University of Nottingham Children's Brain Tumour Research Centre, Nottingham, UK
| | - Laura Kirton
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Oncology, University of Oxford, Oxford, Oxfordshire, UK
| | - Martin G McCabe
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
- Paediatric Oncology, Leeds Children's Hospital, Leeds, West Yorkshire, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Csilla Varnai
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- Department of Paediatric Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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18
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Bailey AJM, Kirkham AM, Monaghan M, Shorr R, Buchan CA, Bredeson C, Allan DS. A Portrait of SARS-CoV-2 Infection in Patients Undergoing Hematopoietic Cell Transplantation: A Systematic Review of the Literature. Curr Oncol 2022; 29:337-349. [PMID: 35049704 PMCID: PMC8774852 DOI: 10.3390/curroncol29010030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
The management of COVID-19 in hematopoietic cell transplant (HCT) recipients represents a special challenge given the variable states of immune dysregulation and altered vaccine efficacy in this population. A systematic search (Ovid Medline and Embase on 1 June 2021) was needed to better understand the presenting features, prognostic factors, and treatment options. Of 897 records, 29 studies were identified in our search. Most studies reporting on adults and pediatric recipients described signs and symptoms that were typical of COVID-19. Overall, the mortality rates were high, with 21% of adults and 6% of pediatric HCT recipients succumbing to COVID-19. The factors reported to be associated with increased mortality included age (HR = 1.21, 95% CI 1.03-1.43, p = 0.02), ICU admission (HR = 4.42, 95% CI 2.25-8.65, p < 0.001 and HR = 2.26, 95% CI 1.22-4.20, p = 0.01 for allogeneic and autologous HCT recipients), and low platelet count (OR = 21.37, 95% CI 1.71-267.11, p = 0.01). Performance status was associated with decreased mortality (HR = 0.83, 95% CI 0.74-0.93, p = 0.001). A broad range of treatments was described, although no controlled studies were identified. The risk of bias, using the Newcastle-Ottawa scale, was low. Patients undergoing HCT are at a high risk of severe morbidity and mortality associated with COVID-19. Controlled studies investigating potential treatments are required to determine the efficacy and safety in this population.
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Affiliation(s)
- Adrian J. M. Bailey
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
| | - Aidan M. Kirkham
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
| | - Madeline Monaghan
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Risa Shorr
- Medical Library and Learning Services, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
| | - C. Arianne Buchan
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Christopher Bredeson
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Transplant & Cellular Therapy in the Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - David S. Allan
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Transplant & Cellular Therapy in the Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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19
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Kebudi R, Chantada G, Kurucu N, Tuğcu D, Mukkada S, C Moreira D. COVID-19: Consequences for Children With Cancer in Turkey and Globally. Turk Arch Pediatr 2022; 56:295-299. [PMID: 35005722 PMCID: PMC8655955 DOI: 10.5152/turkarchpediatr.2021.21134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Rejin Kebudi
- Department of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Guillermo Chantada
- Hemato-oncology Service, Hospital Pereira Rossell, Montevideo, Uruguay.,Hemato-oncology Service, Hospital Universitario Austral, Buenos Aires, Argentina.,Hospital Sant Joan de Deu, Hemato-oncology Service, Barcelona, Spain
| | - Nilgün Kurucu
- Department of Pediatric Oncology, Institute of Cancer, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Tuğcu
- Department of Pediatric Hematology-Oncology, Istanbul University School of Medicine,Istanbul,Turkey
| | - Sheena Mukkada
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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20
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Schlage S, Lehrnbecher T, Berner R, Simon A, Toepfner N. SARS-CoV-2 in pediatric cancer: a systematic review. Eur J Pediatr 2022; 181:1413-1427. [PMID: 35006377 PMCID: PMC8744033 DOI: 10.1007/s00431-021-04338-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/05/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022]
Abstract
UNLABELLED The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan challenges pediatric oncologists in an unexpected way. We provide a comprehensive overview, which systematically summarizes and grades evidence (QoE) on SARS-CoV-2 infections in pediatric cancer patients at 1.5 years of pandemic. A systematic literature search in PubMed combined with an additional exploratory literature review in other international databases was conducted to identify studies on children (aged < 18 years) with a malignant disease and COVID-19 infections. In total, 45 reports on 1003 pediatric cancer patients with SARS-CoV-2 infections were identified out of 1397 reports analyzed. The clinical course of COVID-19 was reported mild or moderate in 358 patients (41.7%), whereas 11.1% of patients showed severe COVID-19. In 12.7% of patients, chemotherapy was postponed, whereas 19% of patients with different underlying malignancies received chemotherapy during SARS-CoV-2 infection. Twenty-five patients with SARS-CoV-2 infections died, potentially related to COVID-19. CONCLUSION Despite a favorable COVID-19 outcome in most pediatric cancer patients, the morbidity is reported higher than in children without comorbidities. However, no severe COVID-19 complications were associated to the continuation of chemotherapy in some cohort studies and reports on two patients. Therefore, the risk of cancer progress or relapse due to interruption of chemotherapy has carefully to be weighed against the risk of severe COVID-19 disease with potentially fatal outcome. WHAT IS KNOWN • Most of pediatric patients with malignant diseases show an asymptomatic, mild or moderate clinical course of SARS-CoV-2 infection. • Current need for a basis for decision-making, whether to stop or interrupt cancer treatment in a patient infected with SARS-CoV-2, and when to continue chemotherapy. WHAT IS NEW • Review results comprising over 1000 pediatric COVID-19 cancer patients confirm mild courses of SARS-CoV-2 infection in most patients but also show the attributable mortality is at least 10 times higher compared to reports on hospitalized children without comorbidities. • Review identifies that chemotherapy was continued despite SARS-CoV-2 positivity in 18% of patients with individual chemotherapy modification according to the clinical course of SARS-CoV-2 infection and existing comorbidities. On this basis, no severe COVID-19 complications were associated to the continuation of chemotherapy in several cohort studies and two case reports.
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Affiliation(s)
- Sandy Schlage
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, University Children’s Hospital, Homburg, Saar, Germany
| | - Nicole Toepfner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
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21
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Kamdar KY, Kim TO, Doherty EE, Pfeiffer TM, Qasim SL, Suell MN, Yates AM, Blaney SM. COVID-19 outcomes in a large pediatric hematology-oncology center in Houston, Texas. Pediatr Hematol Oncol 2021; 38:695-706. [PMID: 34032552 DOI: 10.1080/08880018.2021.1924327] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An understanding of the behavior of SARS-CoV-2 in pediatric hematology-oncology patients is essential to the optimal management of these patients during the COVID-19 pandemic. This study describes the characteristics and outcomes of COVID-19 disease in children with cancer or hematologic disorders treated at a large children's hospital. A retrospective cohort study was conducted at Texas Children's Cancer and Hematology Center from January 1, 2020 to September 30, 2020. All patients with a primary hematology-oncology diagnosis and SARS-CoV-2 positivity by reverse transcription polymerase chain reaction were identified. Clinical and laboratory data were obtained from the medical record. Descriptive analyses were performed to evaluate COVID-19-related outcomes and risk factors for severe disease in this population. We identified 109 patients with COVID-19 disease, including 52 hematology, 51 oncology, and 6 HSCT patients; median age was 10.3 years (IQR 4.4-15.9), and 58.7% were male. Seventy-four percent of the patients were managed in the outpatient setting. Patients with sickle cell disease were more likely to require hospitalization. ICU care was needed in 8% (n = 9) of the entire cohort, and mechanical ventilation was required in 6.4% (6 oncology patients, 1 hematology patient). COVID-19 contributed to the deaths of two cancer patients. No deaths occurred in hematology or HSCT patients. In conclusion, the risk of severe COVID-19 complications is slightly higher in pediatric hematology-oncology patients than in the general pediatric population but lower than initially feared. For most asymptomatic patients, primary disease management may continue as planned, but treatment decisions must be individualized.
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Affiliation(s)
- Kala Y Kamdar
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
| | - Taylor O Kim
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
| | - Erin E Doherty
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
| | - Thomas M Pfeiffer
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
| | - Shawki L Qasim
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
| | - Mary Nell Suell
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
| | - Amber M Yates
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
| | - Susan M Blaney
- Texas Children's Cancer and Hematology Center and Baylor College of Medicine, Department of Pediatrics, Section of Hematology-Oncology, Houston, Texas, USA
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22
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Sharma A, Bhatt NS, Hijano DR. Clinical experience of coronavirus disease 2019 in hematopoietic cell transplant and chimeric antigen receptor T-cell recipients. Curr Opin Hematol 2021; 28:394-400. [PMID: 34456224 DOI: 10.1097/moh.0000000000000683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To discuss the clinical experience of coronavirus disease 2019 (COVID-19) in hematopoietic cell transplant and chimeric antigen receptor T-cell therapy recipients over the past year and to identify key knowledge gaps for future research. RECENT FINDINGS Immunocompromised individuals and those with chronic health conditions are especially susceptible to infections, which have had a disproportionate impact on health outcomes during the COVID-19 pandemic. Several studies have evaluated the clinical characteristics and outcomes of transplant and cellular therapy (TCT) recipients who developed COVID-19. Age, sex, comorbid conditions, and social determinants of health are important predictors of the risk of severe acute respiratory syndrome coronavirus 2 infection and of the eventual severity of the disease. Various treatment approaches have been investigated over the last year. The paradigm of management strategies continues to evolve as more experience is accumulated. SUMMARY In this review, we summarize some important findings as they relate to the clinical characteristics of TCT recipients who develop COVID-19. We also discuss some treatment approaches that are currently recommended and opine on vaccination in this population.
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Affiliation(s)
- Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Diego R Hijano
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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23
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Fonseca EV, Pardo CA, Linares A, López JF, Camacho G, Aponte NH, Bravo DL, Orozco D, Estupiñan M, Chaparro M. Clinical Characteristics and Outcomes of a Cohort of Pediatric Oncohematologic Patients With COVID-19 Infection in the City of Bogotá, Colombia. Pediatr Infect Dis J 2021; 40:499-502. [PMID: 33956754 DOI: 10.1097/inf.0000000000003135] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In children, the complications of severe acute respiratory syndrome coronavirus 2 infection occur less frequently than in adults but the characteristics of this disease in oncology patients are not well characterized. METHODS This was a retrospective study in patients younger than 18 years of age with coronavirus disease 2019 (COVID-19) and cancer diagnoses between April and September 2020. Demographic variables, laboratory, and radiologic findings and complications of each case were identified. A descriptive analysis was performed. RESULTS A total of 33 patients were identified; the median age was 10 years. Fifteen patients (42%) were in chemotherapy at the time of the infection diagnosis, in two patients the chemotherapy protocol was permanently suspended. The most common symptom was fever in 20 patients (60%). Seven patients (21.2%) showed mild pneumonia, four patients (12.1%) severe pneumonia, and three cases (9.0%) were classified as critical. In the evaluated cohort, five patients (15.1%) died, and in two of those, death was caused by COVID-19 infection. CONCLUSIONS Children with an oncologic disease, the search for COVID cases should be oriented to patients with fever, including febrile neutropenia, the presence of respiratory symptoms, and the search for epidemiologic contact. A higher frequency of complications and mortality attributed to COVID-19, two in pediatric oncohematologic patients was found. Institutional strategies to detect the infection early and lower institutional infection are indicated.
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Affiliation(s)
- Eileen V Fonseca
- From the Pediatric Oncology and Hematology Fellowship, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Carlos A Pardo
- Pediatric Oncology Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Adriana Linares
- From the Pediatric Oncology and Hematology Fellowship, Universidad Nacional de Colombia, Bogotá, Colombia
- Pediatric Oncology Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
- Pediatric Infectious Disease Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
- Pediatric Infectious Disease Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
- Pediatric Oncology Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
- Pediatric Intensive Care Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
- Pediatri Unit, HOMI, Fundacion Hospital pediátrico la Misericordia, Bogota, Colombia and
- Bone Marrow Transplant Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
| | - Juan F López
- Pediatric Infectious Disease Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
| | - German Camacho
- Pediatric Infectious Disease Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Nelson H Aponte
- Pediatric Oncology Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
| | - Diana L Bravo
- Pediatric Intensive Care Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
| | - Daniela Orozco
- Pediatri Unit, HOMI, Fundacion Hospital pediátrico la Misericordia, Bogota, Colombia and
| | - Marcela Estupiñan
- Bone Marrow Transplant Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
| | - Mauricio Chaparro
- Bone Marrow Transplant Unit, HOMI, Fundación Hospital pediátrico la Misericordia, Bogotá, Colombia
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24
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Nicastro E, Verdoni L, Bettini LR, Zuin G, Balduzzi A, Montini G, Biondi A, D'Antiga L. COVID-19 in Immunosuppressed Children. Front Pediatr 2021; 9:629240. [PMID: 33996683 PMCID: PMC8116542 DOI: 10.3389/fped.2021.629240] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression-if not associated with other elements of fragility-do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Lucio Verdoni
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Rachele Bettini
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanna Zuin
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Adriana Balduzzi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Andrea Biondi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
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25
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Moreira DC, Millen GC, Sands S, Kearns PR, Hawkins DS. The Care of Children With Cancer During the COVID-19 Pandemic. Am Soc Clin Oncol Educ Book 2021; 41:1-10. [PMID: 33989020 DOI: 10.1200/edbk_321497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has considerably changed health services for children with cancer worldwide by creating barriers throughout the care continuum. Reports available at this time suggest that asymptomatic and mild upper and lower respiratory tract syndromes are the most common presentation of COVID-19 in children with cancer. Nonetheless, severe cases of COVID-19 and deaths secondary to the infection have been reported. In addition to the direct effects of the severe acute respiratory syndrome coronavirus 2, children with cancer have suffered from the collateral consequences of the pandemic, including decreased access to diagnosis and cancer-directed therapy. The COVID-19 pandemic has presented unprecedented challenges to safe and effective care of children with cancer, including their enrollment in therapeutic clinical trials. Data from the Children's Oncology Group and Cancer Research U.K. Clinical Trials Unit show variability in the enrollment of children with cancer in clinical trials during the COVID-19 pandemic. However, the overall effects on outcomes for children with cancer undergoing care during the pandemic remain largely unknown. In this article, we review the current knowledge about the direct and collateral effects of the COVID-19 pandemic, including on clinical trial enrollment and operations.
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Affiliation(s)
| | - Gerard C Millen
- Birmingham Children's Hospital, Birmingham, United Kingdom
- Cancer Research U.K. Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephen Sands
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pamela R Kearns
- Birmingham Children's Hospital, Birmingham, United Kingdom
- Cancer Research U.K. Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Douglas S Hawkins
- Seattle Children's Hospital Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
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Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients. Blood 2021; 136:2881-2892. [PMID: 33113551 PMCID: PMC7746126 DOI: 10.1182/blood.2020008824] [Citation(s) in RCA: 427] [Impact Index Per Article: 142.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
Adult patients with hematologic malignancy and COVID-19 found a 34% risk of death, whereas pediatric patients had a 4% risk of death. Patients on systemic anticancer therapy had a similar risk of death to patients on no treatment (RR, 1.17; 95% CI, 0.83-1.64).
Outcomes for patients with hematologic malignancy infected with COVID-19 have not been aggregated. The objective of this study was to perform a systematic review and meta-analysis to estimate the risk of death and other important outcomes for these patients. We searched PubMed and EMBASE up to 20 August 2020 to identify reports of patients with hematologic malignancy and COVID-19. The primary outcome was a pooled mortality estimate, considering all patients and only hospitalized patients. Secondary outcomes included risk of intensive care unit admission and ventilation in hospitalized patients. Subgroup analyses included mortality stratified by age, treatment status, and malignancy subtype. Pooled prevalence, risk ratios (RRs), and 95% confidence intervals (CIs) were calculated using a random-effects model. Thirty-four adult and 5 pediatric studies (3377 patients) from Asia, Europe, and North America were included (14 of 34 adult studies included only hospitalized patients). Risk of death among adult patients was 34% (95% CI, 28-39; N = 3240) in this sample of predominantly hospitalized patients. Patients aged ≥60 years had a significantly higher risk of death than patients <60 years (RR, 1.82; 95% CI, 1.45-2.27; N = 1169). The risk of death in pediatric patients was 4% (95% CI, 1-9; N = 102). RR of death comparing patients with recent systemic anticancer therapy to no treatment was 1.17 (95% CI, 0.83-1.64; N = 736). Adult patients with hematologic malignancy and COVID-19, especially hospitalized patients, have a high risk of dying. Patients ≥60 years have significantly higher mortality; pediatric patients appear to be relatively spared. Recent cancer treatment does not appear to significantly increase the risk of death.
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Dorantes-Acosta E, Ávila-Montiel D, Klünder-Klünder M, Juárez-Villegas L, Márquez-González H. Survival and Complications in Pediatric Patients With Cancer and COVID-19: A Meta-Analysis. Front Oncol 2021; 10:608282. [PMID: 33552980 PMCID: PMC7861039 DOI: 10.3389/fonc.2020.608282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background The pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected all age groups, including the pediatric population, in 3–5% of all cases. We performed a meta-analysis to understand the survival and associated complications in pediatric cancer patients as well as their hospitalization, intensive care, and ventilation care (supplemental oxygen/endotracheal intubation) needs. Methods A systematic search was performed using MEDLINE, TRIP Database, International Clinical Trials Registry Platform (WHO), The Cochrane Library, Wiley, LILACS, and Google Scholar. Additionally, a search using the snowball method was performed in Nature, New England Journal of Medicine, Science, JAMA, ELSEVIER editorial, Oxford University Press, The Lancet, and MedRxiv. Searches were conducted until July 18, 2020. A total of 191 cancer patients with coronavirus disease 2019 (COVID-19) were integrated from 15 eligible studies. In a sub-analysis, patients were stratified into two groups: hematological cancer and solid tumors. Outcome measures were overall survival, risk of hospitalized or needing intensive care, and need for ventilatory support in any modality. The random effects statistical analysis was performed with Cochran’s chi square test. The odds ratio (OR) and heterogeneity were calculated using the I2 test. Results The overall survival was 99.4%. There were no statistically significant differences in the risk of hospitalization between hematological malignancies and solid tumors (95% confidence interval [CI] 0.48–18.3; OR = 2.94). The risk of being admitted to the intensive care unit was also not different between hematological malignancies and other tumors (95% CI 0.35–5.81; OR = 1.42). No differences were found for the need of ventilatory support (95% CI 0.14–3.35; OR = 0.68). Although all the studies were cross-sectional, the mortality of these patients was 0.6% at the time of analysis. Conclusions In the analyzed literature, survival in the studied group of patients with COVID-19 was very high. Suffering from hematological neoplasia or other solid tumors and COVID-19 was not a risk factor in children with cancer for the analyzed outcomes.
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Affiliation(s)
- Elisa Dorantes-Acosta
- Biobanco de Investigación en Células Leucémicas, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Diana Ávila-Montiel
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Miguel Klünder-Klünder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Luis Juárez-Villegas
- Departamento de Onco-Hematología, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Horacio Márquez-González
- Investigación Clínica, Hospital Infantil de México Federico Gómez, México City, Mexico.,Cardiopatías Congénitas. Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
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