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Ganguly S, Sasi A, Sra MS, Sharma S, Sharma S, Kumari M, Pushpam D, Bakhshi S. The Utility and Impact of Telemedicine in Childhood Cancer Care: A Mixed Methods Study. Pediatr Blood Cancer 2025; 72:e31552. [PMID: 39833505 DOI: 10.1002/pbc.31552] [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: 09/06/2024] [Revised: 12/26/2024] [Accepted: 01/07/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND While teleconsultation has proven feasible for adult cancer patients, its utility in childhood cancer care in India is unknown. This study assesses caregiver satisfaction, feasibility, and the economic impact of teleconsultation for children with cancer. PROCEDURE This mixed methods study was conducted in the pediatric cancer outpatient service at a tertiary care cancer center in India. Routine care teleconsultations were performed via telephone or email. Caregivers who received teleconsultations during the study period or 6 months prior were interviewed by phone. Data collected included demographic details, teleconsultation usage patterns, caregiver satisfaction, reasons for satisfaction or dissatisfaction, and cost savings. Logistic regression identified baseline characteristics associated with satisfaction. In-depth interviews were conducted in a separate cohort till thematic saturation. RESULTS Caregivers of 465 children were included for telephonic and eight for in-depth interviews Among the respondents, 72.8% (n = 339) were satisfied with teleconsultation, and 85.4% (n = 397) of those planned to continue using it. Significant reasons for satisfaction were cost and time savings, while difficulty explaining issues caused dissatisfaction. Multivariable analysis showed parental education above high school [OR: 1.59, p = 0.035] increased satisfaction likelihood, while a residential distance of greater than 100 km from the hospital [OR: 0.62, p = 0.033] decreased it. Median cost savings per visit was $24.2 (range: $1-$846). Cost savings did not determine satisfaction magnitude. Frequently cited themes included cost and time savings and the need for literacy to benefit from teleconsultation. CONCLUSIONS Teleconsultation is feasible and effective for routine childhood cancer care, even in resource-constrained settings.
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Affiliation(s)
- Shuvadeep Ganguly
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Archana Sasi
- Division of Leukemia, Dana-Farber Cancer Institute, Brooklyn, Massachusetts, USA
| | | | - Swetambri Sharma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shubhangi Sharma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mamta Kumari
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Wang W, Xu X, Bai S, Wang L, Luo J, Zhao D, Li P, Fan Q, Wang C, Yao Q, Li B, Wang D. Clinical characteristics and prognosis of SARS-CoV-2 infection in children with hematological malignancies: A multicenter, retrospective study in China. Pediatr Neonatol 2024; 65:553-559. [PMID: 38553357 DOI: 10.1016/j.pedneo.2023.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/10/2023] [Accepted: 12/27/2023] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Data on SARSCoV-2 infection in children with hematological malignancies (HM) are limited. Here, we describe the clinical features of children with HM after SARS-CoV-2 infection and investigate the potential risk factors for disease severity. METHODS Children with HM and SARS-CoV-2 infection from five hospitals in five cities in Henan, China from October 2022 to January 2023 were retrospectively included. Clinical information and Coronavirus disease 2019 (COVID-19) vaccination status were collected for further analyses. RESULTS A total of 285 children with HM and SARS-CoV-2 infections were included. COVID-19 was asymptomatic in 3.2% of the patients (n = 9), mild in 89.1% (n = 254), moderate in 5.3% (n = 15), severe in 1.8% (n = 5), and critical in 0.7% (n = 2). Fever (92.4%) and cough (56.9%) were the most common symptoms. Most (249, 88.3%) children were managed at home during their COVID-19 illness. Of the 36 children admitted to the hospital, two required intensive care unit care, 11 required supplementary oxygen, and two non-invasive ventilation. A total of 283 (99.3%) children fully recovered and two (0.7%) died due to COVID-19. Significant risk factors for increased severity of infection in multivariable analyses were the presence of comorbidity (OR, 10.4; 95%CI, 2.8-38.7; p < 0.0001), neutropenia (OR, 10.4; 95%CI, 2.6-41.8; p = 0.001), and lymphopenia (OR, 4.2; 95%CI, 1.2-15.4; p = 0.029). A total of 30.9% (88/285) of the children received at least one dose of the inactivated COVID-19 vaccine at COVID-19 diagnosis. Compared with children who received at least one dose of the COVID-19 vaccine, fever was significantly more common in unvaccinated children (79.3% vs. 93.8%, p < 0.001). CONCLUSIONS Children with HM are not at an increased risk of severe COVID-19 compared to the general pediatric population. However, comorbidities such as lymphopenia and neutropenia may increase the risk of developing moderate or severe/critical disease. Our data may help in management decisions for this vulnerable population.
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Affiliation(s)
- Weilin Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueju Xu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Songting Bai
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lu Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jixia Luo
- Department of Hematology, Children's Hospital of Kaifeng City, Kaifeng, China
| | - Daiyan Zhao
- Department of Pediatrics, The Second People's Hospital of Luohe City, Luohe, China
| | - Ping Li
- Department of Pediatrics, Maternal and Child Health Hospital of Zhoukou City, Zhoukou, China
| | - Qiuxia Fan
- Department of Pediatrics, The First People's Hospital of Shangqiu City, Shangqiu, China
| | - Chunmei Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianghua Yao
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bai Li
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dao Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Arian Y, Faranoush P, Ehsanipour F, Sadighnia N, Elahinia A, Faranoush M. Clinical Outcomes of Pediatric Cancer Patients with COVID-19: A Cross-Sectional Study. Int J Hematol Oncol Stem Cell Res 2024; 18:313-322. [PMID: 39703466 PMCID: PMC11652701 DOI: 10.18502/ijhoscr.v18i4.16756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 07/27/2024] [Indexed: 12/21/2024] Open
Abstract
Background: Considering the widespread COVID-19 pandemic and its impact, especially on children, particularly those with cancer, in terms of transmission risk, mortality, and the occurrence of the disease based on various studies in different countries, we decided to conduct this study to improve the care of children with cancer regarding COVID-19. Materials and Methods: A descriptive cross-sectional study with a confirmed diagnosis of COVID-19 consisted of obtaining 20 mL of blood samples from the participants in a random manner. Diagnostic examinations, including CT scans, chest X-rays, and a range of hematologic and blood tests, such as complete blood count, ESR, CRP, and D-Dimer, were performed on all patients. Results: This study contains 26 males and 12 females. The mean age of the patients was 3.81 ± 6.35 years. The majority of cancer patients with COVID-19 were diagnosed with Acute Lymphoblastic Leukemia (ALL) (47.7%). The most common symptoms of COVID-19 in the patients were fever (73.7%), cough (39.5%), and nausea/vomiting (21.1%). 40.4% of the patients had pathological findings suggestive of COVID-19 on their chest CT scans. 60.52% of the patients had an elevated Erythrocyte Sedimentation Rate (ESR), and 73.68% had an elevated C-reactive protein (CRP) level. Conclusion: Despite the outcomes of COVID-19 in most children with cancer in this study, children with cancer still experience risks from COVID-19, and it is unclear how delays and interruptions in cancer treatment and direct damage from the virus may impact long-term outcomes in these patients.
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Affiliation(s)
- Yasaman Arian
- Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran
| | - Pooya Faranoush
- Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran
| | - Fahime Ehsanipour
- Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran
| | - Negin Sadighnia
- Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Elahinia
- Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran
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Reis GMS, Clemente HA, da Silva JA, Barros Neto JA, de Oliveira ACM, Mello CS. Clinical and Nutritional Aspects and Outcomes of Covid-19 in Cancer and Non-Cancer Pediatric Patients. Nutr Cancer 2024; 77:179-187. [PMID: 39340409 DOI: 10.1080/01635581.2024.2408765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 09/17/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024]
Abstract
The SARS-CoV-2 virus has been the subject of study by several researchers worldwide since 2020; however, there are points to be clarified. This study aimed to analyze the clinical and nutritional aspects of hospitalized cancer and non-cancer pediatric patients and the association with COVID-19 outcomes. This is a cohort study of hospitalized children and adolescents with a laboratory diagnosis of COVID-19. Patients were assessed according to the presence or absence of previous oncological diseases. Sociodemographic, clinical and nutritional data were investigated during the course of the infection. Outcomes included Intensive Care Unit (ICU) admission, longer length of stay (14 days), criticality, and death. Oncological disease was found in 16 (19.3%) patients, most of whom had B-type acute lymphoid leukemia. In Poisson regression, adjusted for age and comorbidity, an association was found between oncological disease and length of stay ≥14 days (RR 4.30; 95% CI 1.46 - 15.6; p = 0.013), COVID-19 criticality (RR 3.82; 95% CI 1.66 - 30.9; p = 0.010) and death (RR 3.42; 95% CI 0.94 - 9.96; p = 0.035). The research revealed that cancer patients had longer hospital stays, were more likely to have the severe form of COVID-19, and had a 3.42 times greater risk of dying.
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Chávez-Pacheco JL, Castillejos-López M, Hernández-Regino LM, Velasco-Hidalgo L, Zapata-Tarres M, Correa-Carranza V, Rosario-Méndez G, Barrientos-Ríos R, Aquino-Gálvez A, Torres-Espíndola LM. Challenges in Treating Pediatric Cancer Patients during the COVID-19 Pandemic: Balancing Risks and Care. Viruses 2024; 16:690. [PMID: 38793571 PMCID: PMC11125850 DOI: 10.3390/v16050690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The COVID-19 pandemic has resulted in millions of fatalities worldwide. The case of pediatric cancer patients stands out since, despite being considered a population at risk, few studies have been carried out concerning symptom detection or the description of the mechanisms capable of modifying the course of the COVID-19 disease, such as the interaction and response between the virus and the treatment given to cancer patients. By synthesizing existing studies, this paper aims to expose the treatment challenges for pediatric patients with COVID-19 in an oncology context. Additionally, this updated review includes studies that utilized the antiviral agents Remdesivir and PaxlovidTM in pediatric cancer patients. There is no specific treatment designed exclusively for pediatric cancer patients dealing with COVID-19, and it is advisable to avoid self-medication to prevent potential side effects. Managing COVID-19 in pediatric cancer patients is indeed a substantial challenge. New strategies, such as chemotherapy application rooms, have been implemented for children with cancer who were positive for COVID-19 but asymptomatic since the risk of disease progression is greater than the risk of complications from SARS-CoV-2.
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Affiliation(s)
- Juan Luis Chávez-Pacheco
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | - Manuel Castillejos-López
- Epidemiology and Infectology, National Institute of Respiratory Diseases, Mexico City 14080, Mexico;
| | - Laura M. Hernández-Regino
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | | | - Marta Zapata-Tarres
- Head of Research Coordination at Mexican Social Security Institute Foundation, Mexico City 06600, Mexico;
| | - Valeria Correa-Carranza
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | - Guillermo Rosario-Méndez
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
| | - Rehotbevely Barrientos-Ríos
- Cytogenetics Laboratory, Department of Human Genetics, National Institute of Pediatrics, Mexico City 04530, Mexico;
| | - Arnoldo Aquino-Gálvez
- Molecular Biology Laboratory, Pulmonary Fibrosis Department, National Institute of Respiratory Diseases, Mexico City 14080, Mexico
| | - Luz María Torres-Espíndola
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City 04530, Mexico; (J.L.C.-P.); (L.M.H.-R.); (V.C.-C.); (G.R.-M.)
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Huang Y, Zhou H, Wang Y, Xiao L, Qin W, Li L. A comprehensive investigation on the receptor BSG expression reveals the potential risk of healthy individuals and cancer patients to 2019-nCoV infection. Aging (Albany NY) 2024; 16:5412-5434. [PMID: 38484369 PMCID: PMC11006473 DOI: 10.18632/aging.205655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly emerging coronavirus. BSG (basigin) is involved in the tumorigenesis of multiple tumors and recently emerged as a novel viral entry receptor for SARS-CoV-2. However, its expression profile in normal individuals and cancer patients are still unclear. METHODS We performed a comprehensive analysis of the expression and distribution of BSG in normal tissues, tumor tissues, and cell lines via bioinformatics analysis and experimental verification. In addition, we investigated the expression of BSG and its isoforms in multiple malignancies and adjacent normal tissues, and explored the prognostic values across pan-cancers. Finally, we conducted function analysis for co-expressed genes with BSG. RESULTS We found BSG was highly conserved in different species, and was ubiquitously expressed in almost all normal tissues and significantly increased in some types of cancer tissues. Moreover, BSG at mRNA expression level was higher than ACE2 in normal lung tissues, and lung cancer tissues. High expression of BSG indicated shorter overall survival (OS) in multiple tumors. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses indicated that BSG is mostly enriched in genes for mitochondria electron transport, oxidoreduction-driven active transmembrane transporter activity, mitochondrial inner membrane, oxidative phosphorylation, and genes involving COVID-19. CONCLUSIONS Our present work emphasized the value of targeting BSG in the treatment of COVID-19 and cancer, and also provided several novel insights for understanding the SARS-CoV-2 pandemic.
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Affiliation(s)
- Yongbiao Huang
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Haiting Zhou
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Wang
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Lingyan Xiao
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wan Qin
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Long Li
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Yılmaz Çelebi M, Şahinkaya Ş, Cem E, Akaslan Kara A, Özdağ E, Ayhan FY, Karakaya N, Odaman Al I, Gözmen S, Hilkay Karapınar T, Oymak Y, Bayram SN, Devrim İ. A hidden burden of disease in a specific group: Evaluation of COVID-19 seroconversion rates in pediatric patients with leukemia. Am J Infect Control 2024; 52:320-323. [PMID: 37726054 DOI: 10.1016/j.ajic.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND SARS-CoV-2, a respiratory viral disease, is thought to have a more severe course in patients with malignancy and low immune systems. METHODS This prospective single-center study was conducted at the University of Health Sciences Dr Behçet Uz Children's Hospital from September 22 to December 31, 2021. Asymptomatic COVID-19 transmission rates were assessed using SARS-CoV-2 serology in patients with leukemia who had no history of COVID-19 infection. RESULTS Among the 54 patients, 19 (35.2%) were females and 35 (64.8%) were males. The median age was 5.5 years (min 6 months, max 17 years). Forty-nine (90.5%) of the leukemia patients had acute lymphoblastic leukemia, while 5 (9.5%) had acute myeloid leukemia. Five of the 54 patients had a history of COVID-19 or contact with a positive person. SARS-CoV-2 IgG positivity was detected in 18 (36.7%) of 49 patients with no history of COVID-19 infection. DISCUSSION Leukemia patients have a high seroconversion for SARS-CoV-2 without showing any symptoms supporting the asymptomatic course of COVID-19 infection in this risk group. CONCLUSION As a result, patients with leukemia may have a high rate of COVID-19 seroconversion without showing symptoms.
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Affiliation(s)
- Miray Yılmaz Çelebi
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey.
| | - Şahika Şahinkaya
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Ela Cem
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Aybüke Akaslan Kara
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Eda Özdağ
- Department of Pediatrics, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Fahri Y Ayhan
- Department of Microbiology, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Nurgül Karakaya
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Işık Odaman Al
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Salih Gözmen
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Tuba Hilkay Karapınar
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Süleyman N Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
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Shati AA, Mahmood SE, Alsuheel Asseri A, Alhanshani AA, Alqahtani YA, Ahmad A. SARS-CoV-2 infections and MIS-C among children: A narrative review. Medicine (Baltimore) 2023; 102:e34475. [PMID: 37543809 PMCID: PMC10402996 DOI: 10.1097/md.0000000000034475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 08/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has less of an impact among the babies and teenagers, than it does on adults as a whole. Children turned out to be less symptomatic during the coronavirus disease (COVID-19) surge worldwide. Researchers discovered the ways of protection by preemptive care, like, treatment, variants, vaccination, social distancing, and cohorting among children as soon as their medical and epidemiological factors were assessed while being exposed to SARS-CoV-2 transmission. The actual pervasiveness of asymptomatic SARS-CoV-2 contagion is possibly undervalued because of less examination of the asymptomatic children. A half of young-aged people who tested SARS-CoV-2 positive don't show any symptoms as per the study of serology. Nevertheless, there is wide circulation of information reporting a post-infectious acute illness known as multisystem inflammatory syndrome in children (MIS-C) or multisystem hyperinflammatory syndrome. Therefore, we undertook this narrative review to synthesize the evidence from existing studies to assess the relationship between SARS-CoV-2 infections and MIS-C among Children. We reviewed PubMed, Science Direct, and Google Scholar to find the pertinent scientific papers published in English that were available for such analysis. The main purpose of this article is to present, on this limited topic, a better-comprehended review covering pertinent material and data to be informed on SARS-CoV-2 infections and MIS-C among Children.
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Affiliation(s)
- Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Syed Esam Mahmood
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ali Alsuheel Asseri
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ahmad A. Alhanshani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ausaf Ahmad
- Department of Community Medicine, Integral University, Lucknow, India
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Martin SD, Nziza N, Miozzo P, Bartsch Y, Farkas EJ, Kane AS, Boal LH, Friedmann A, Alter G, Yonker LM. Humoral profiling of pediatric patients with cancer reveals robust immunity following anti-SARS-CoV-2 vaccination superior to natural infection. Pediatr Blood Cancer 2023; 70:e30473. [PMID: 37249415 PMCID: PMC10321888 DOI: 10.1002/pbc.30473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Pediatric patients with cancer infected with COVID-19 may be at higher risk of severe disease and may be unable to mount an adequate response to the virus due to compromised immunity secondary to their cancer therapy. PROCEDURE This study presents immunologic analyses of 20 pediatric patients with cancer, on active chemotherapy or having previously received chemotherapy, and measures their immunoglobulin titers and activation of cellular immunity response to acute SARS-CoV-2 infection and COVID-19 vaccination compared with healthy pediatric controls. RESULTS Forty-three patients were enrolled, of which 10 were actively receiving chemotherapy, 10 had previously received chemotherapy, and 23 were healthy controls. Pediatric patients with cancer had similar immunoglobulin titers, antibody binding capacity, and effector function assay activity after vaccination against COVID-19 compared with healthy controls, though more variability in response was noted in the cohort actively receiving chemotherapy. Compared with acute infection, vaccination against COVID-19 produced superior immunoglobulin responses, particularly IgA1, IgG1, and IgG3, and elicited superior binding capacity and effector function in children with cancer and healthy controls. CONCLUSIONS Pediatric patients receiving chemotherapy and those who had previously received chemotherapy had adequate immune activation after both vaccination and acute infection compared to healthy pediatric controls, although there was a demonstrated variability in response for the patients on active chemotherapy. Vaccination against COVID-19 produced superior immune responses compared to acute SARS-CoV-2 infection in pediatric patients with cancer and healthy children, underscoring the importance of vaccination even in previously infected individuals.
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Affiliation(s)
- Samantha D Martin
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nadège Nziza
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Boston, Massachusetts, USA
| | - Pietro Miozzo
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yannic Bartsch
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Boston, Massachusetts, USA
| | - Eva J Farkas
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Abigail S Kane
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren H Boal
- Department of Pediatrics, Hematology/Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison Friedmann
- Department of Pediatrics, Hematology/Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lael M Yonker
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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Elgarten CW, Kairalla JA, Thompson JC, Miller TP, Wang C, Conway S, Loh ML, Raetz EA, Gupta S, Rau RE, Angiolillo A, Rabin KR, Alexander S. SARS-CoV-2 infections in patients enrolled on the Children's Oncology Group standard-risk B-cell acute lymphoblastic leukemia trial, AALL1731. EJHAEM 2023; 4:745-750. [PMID: 37601850 PMCID: PMC10435702 DOI: 10.1002/jha2.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 08/22/2023]
Abstract
Hematologic malignancy is a risk factor for severe coronavirus disease 2019 (COVID-19) in adults; however, data specific to children with leukemia are limited. High-quality infectious adverse event data from the ongoing Children's Oncology Group (COG) standard-risk B acute lymphoblastic leukemia/lymphoma (ALL/LLy) trial, AALL1731, were analyzed to provide a disease-specific estimate of SARS-CoV-2 infection outcomes in pediatric ALL. Of 253 patients with reported infections, the majority (77.1%) were asymptomatic or mildly symptomatic (CTCAE grade 1/2) and there was a single COVID-19-related death. These data suggest SARS-CoV-2 infection does not confer substantial morbidity among young patients with B-lymphoblastic leukemia/lymphoma (B-ALL/LLy).
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Affiliation(s)
- Caitlin W. Elgarten
- Department of PediatricsDivision of OncologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - John A. Kairalla
- Department of BiostatisticsUniversity of FloridaGainesvilleFloridaUSA
| | - Joel C. Thompson
- Department of PediatricsDivision of Hematology/Oncology/Bone Marrow TransplantChildren's Mercy HospitalUniversity of Missouri ‐ Kansas CityKansas CityMissouriUSA
| | - Tamara P. Miller
- Pediatric Hematology/OncologyChildren's Healthcare of Atlanta ‐ EglestonAtlantaGeorgiaUSA
| | - Cindy Wang
- Department of BiostatisticsUniversity of FloridaGainesvilleFloridaUSA
| | - Susan Conway
- Department of BiostatisticsUniversity of FloridaGainesvilleFloridaUSA
| | - Mignon L. Loh
- Ben Towne Center for Childhood Cancer ResearchSeattle Children's Research Institute and Department of PediatricsSeattle Children's HospitalUniversity of WashingtonSeattleWashingtonUSA
| | - Elizabeth A. Raetz
- Laura and Isaac Perlmutter Cancer Center at NYU LangoneNew YorkNew YorkUSA
| | - Sumit Gupta
- Division of Hematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
| | - Rachel E. Rau
- Pediatric Hematology/OncologyBaylor College of MedicineHoustonTexasUSA
| | - Anne Angiolillo
- Center for Cancer and Blood DisordersChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Karen R. Rabin
- Pediatric Hematology/OncologyBaylor College of MedicineHoustonTexasUSA
| | - Sarah Alexander
- Division of Hematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
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11
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Latella A, Gómez S, Palladino M, Navia M, Mangano A, Borgnia D, Rino P, González C, Felice MS, Rose A, Alderete D, Staciuk R, Roizen M, Fraquelli L. COVID-19 in Pediatric Cancer Patients and Hematopoietic Stem Cell Transplant Recipients in a Tertiary Care Hospital in Argentina. J Pediatr Hematol Oncol 2023; 45:e671-e677. [PMID: 37314943 DOI: 10.1097/mph.0000000000002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
The outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in cancer pediatric patients was initially uncertain. The objective of this study was to describe the characteristics and outcome of cancer patients and hematopoietic stem cell transplant recipients from 0 to 19 years with detectable SARS-CoV-2 from April 23, 2020, to April 30, 2022, treated in a tertiary-level hospital in Argentina. A total of 348 cases were registered in 339 patients. The median age was 89.5 (3 to 224) months. The sex was predominantly male: 193 (55.5%). The most common malignant disease was leukemia (42.8%). One hundred four cases (29.9%) had comorbidities. Of the 346 cases with an available blood count, 17.6% had a lymphocyte count <300/mm 3 . Fever was the most common symptom. In most cases (93.1%) presented asymptomatic or mild disease. Twenty-one cases (6%) presented severe or critical status. Eleven of 24 admissions to the intensive care unit were due to COVID-19 (coronavirus disease 2019). Eight patients (2.3%) died. Two deaths were attributable to SARS-CoV-2 (0.6%). Being older, having fever, lymphopenia at diagnosis, and having received hematopoietic stem cell transplant were associated with a more severe disease. Around 90% of the children continued their cancer treatment without any change.
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Affiliation(s)
| | | | | | | | - Andrea Mangano
- Virology and Molecular Epidemiology Unit, Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Daniela Borgnia
- Virology and Molecular Epidemiology Unit, Pediatría JP Garrahan, Buenos Aires, Argentina
| | | | | | | | | | | | - Raquel Staciuk
- Stem Cell Transplantation, Hospital de Pediatría JP Garrahan
| | - Mariana Roizen
- Stem Cell Transplantation, Hospital de Pediatría JP Garrahan
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12
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Martin SD, Davis ES, Dai C, Boal LH, Araya B, Brackett J, Dickens D, Kahn A, Martinez I, Sharma A, Schwalm C, Aguayo-Hiraldo P, Bhatia S, Levine JM, Johnston EE, Wolfson JA. Clinical Features and Risk Factors Associated With Multisystem Inflammatory Syndrome in Children With Cancer and COVID-19. JAMA Oncol 2023; 9:1108-1112. [PMID: 37166782 PMCID: PMC10176181 DOI: 10.1001/jamaoncol.2023.0525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/27/2023] [Indexed: 05/12/2023]
Abstract
Importance Little is known about the risk of post-COVID-19 multisystem inflammatory syndrome in children (MIS-C) in the setting of childhood cancer. Objective To evaluate factors associated with MIS-C and describe the clinical course of COVID-19 in the setting of MIS-C. Design, Setting, and Participants Multisite observational cohort study of a registry representing more than 100 US pediatric oncology sites. All included patients were registered between April 1, 2020, and May 18, 2022. Sites submitted deidentified data surrounding sociodemographics, cancer diagnosis and treatment, and COVID-19 course (symptoms, maximum support required, outcome). Patients with MIS-C (n = 24) were compared with matched controls (n = 96). Children (<21 years) with cancer who developed COVID-19 while receiving cancer treatment or within 1 year of completing treatment were characterized based on their development of MIS-C. Exposures (1) Clinical and sociodemographic characteristics of children with cancer and COVID-19; and (2) MIS-C. Main Outcomes and Measures (1) Development of MIS-C among children with cancer and COVID-19; and (2) symptoms and disease severity associated with MIS-C. Results Among 2035 children with cancer and COVID-19, 24 (1.2%) developed MIS-C. COVID-19 occurred at a median (IQR) age of 12.5 (5.5-17.1) years in those with MIS-C and 11 (6-16) years among matched controls (P = .86). The majority of children with MIS-C had a hematologic cancer (83.3% [n = 20]), were publicly insured (66.7% [n = 16]), and were Hispanic (54.2% [n = 13]). Half (n = 12) had 1 or more noncancer comorbidity. Those with comorbidities were more likely to develop MIS-C than those without (odds ratio [OR], 2.5 [95% CI, 1.1-5.7]). Among children with MIS-C, 100% (n = 24) were admitted to the hospital and 54.2% (n = 13) to the intensive care unit (ICU), while COVID-19 contributed to the death of 20.1% (n = 5); cancer therapy was changed in 62.5% (n = 15). Compared with matched controls, those with MIS-C had higher odds of symptoms classified as systemic (OR, 4.7 [95% CI, 1.4-15.8]) or gastrointestinal (OR, 5.0 [95% CI, 1.7-14.6]) along with higher odds of hospitalization (OR, 42.9 [95% CI, 7.1-258]), ICU admission (OR, 11.4 [95% CI, 3.6-36.4]), and changes to cancer therapy (OR, 24.9 [95% CI, 6.5-94.8]). Conclusions and Relevance In this cohort study among children with cancer and COVID-19, those with MIS-C had a more severe clinical course than those without MIS-C. The risk of MIS-C and its severity are important to consider as clinicians monitor patients with COVID-19. These findings can inform their conversations with families regarding COVID-19 risks and the benefits of prevention strategies that are pharmacologic (vaccination) and nonpharmacologic (masking), as well as treatment (antivirals, monoclonal antibodies).
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Affiliation(s)
| | - Elizabeth S. Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Lauren H. Boal
- Department of Pediatrics, Massachusetts General Hospital, Boston
| | - Brook Araya
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children’s Hospital, Houston
| | - David Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City
| | - Alissa Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph’s University Medical Center, Paterson, New Jersey
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, Kalamazoo, Michigan
| | - Paibel Aguayo-Hiraldo
- Division of Hematology-Oncology, Department of Pediatrics, Children’s Hospital of Los Angeles, Los Angeles, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham
| | - Jennifer M. Levine
- Pediatric Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | - Emily E. Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham
| | - Julie A. Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham
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de Andrade-Lima ALM, Lins MM, Borborema MDCD, Matos APR, de Oliveira KMM, Gonçalves Mello MJ. The Infection Profile and Survival of Children and Adolescents With COVID-19 Undergoing Cancer Treatment: A Cohort Study. Pediatr Infect Dis J 2023; 42:614-619. [PMID: 37053592 PMCID: PMC10289072 DOI: 10.1097/inf.0000000000003928] [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] [Accepted: 03/12/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the clinical evolution of coronavirus disease 2019 (COVID-19) in children and adolescents with cancer. METHODS Cohort involving patients undergoing cancer treatment, 19 years old and under, with the diagnosis of COVID-19 by real-time polymerase chain reaction, in a reference hospital, between March 2020 and November 2021. Data were collected from medical records and interviews with patients and/or guardians. The primary outcomes studied were severe/critical COVID-19 presentation, deaths from any cause and overall survival. The Cox proportional hazards multivariate regression analysis was performed to determine the risk of death. RESULTS Sixty-two participants were included, most (67.7%) were male, with a median age of 6.8 years. Severe/critical forms of COVID-19, observed in 24.2%, seemed to indicate that the pediatric population undergoing cancer treatment has a higher morbidity rate than the general pediatric population (8-9.2%). During follow-up (4.5-18 months), 20 patients (32.3%) completed their cancer treatment and 18 died (29%)-6 during hospitalization and 12 after discharge. In total 61.1% of deaths occurred within 63 days of a detectable real-time polymerase chain reaction. Patients with a higher risk of death presented with severe/critical COVID-19 [adjusted hazard risk (aHR): 8.51; 95% confidence interval (CI): 2.91-24.80; P < 0.00] solid tumors (aHR: 3.99; 95% CI: 1.43-11.12; P = 0.008) and diarrhea as a symptom of COVID-19 (aHR: 3.9; 95% CI: 1.23-12.73; P = 0.021). CONCLUSIONS These findings support the impact that severe acute respiratory syndrome-associated coronavirus 2 infection has on the population of children and adolescents with cancer, not only regarding immediate severity but also in their survival rate. Further studies evaluating long-term outcomes of COVID-19 in children and adolescents with cancer should be encouraged.
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Affiliation(s)
| | - Mecneide Mendes Lins
- Departamento de Oncologia Pediátrica, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Maria do Céu Diniz Borborema
- Departamento de Oncologia Pediátrica, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Ana Paula Rodrigues Matos
- Departamento de Oncologia Pediátrica, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil
| | | | - Maria Júlia Gonçalves Mello
- Departamento de pós-graduação strictu sensu, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), docente e pesquisadora da pós-graduação do IMIP, Recife, PE, Brazil
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14
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Nigro O, Oltolini C, Barzaghi F, Uberti Foppa C, Cicalese MP, Massimino M, Schiavello E. Pediatric cancer care management during the COVID-19 pandemic: a review of the literature and a single-centre real-life experience of an Italian pediatric oncology unit. Expert Rev Anticancer Ther 2023; 23:927-942. [PMID: 37712347 DOI: 10.1080/14737140.2023.2245148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The severe acute respiratory syndrome coronavirus-2 pandemic significantly affected clinical practice, also in pediatric oncology units. Cancer patients needed to be treated with an adequate dose density despite the SARS-CoV-2 infection, balancing risks of developing severe COVID-19 disease. AREAS COVERED Although the pandemic spread worldwide, the prevalence of affected children was low. The percentage of children with severe illness was approximately 1-6%. Pediatric cancer patients represent a prototype of a previously healthy immune system that is hampered by the tumor itself and treatments, such as chemotherapy and steroids. Through a review of the literature, we reported the immunological basis of the response to SARS-CoV-2 infection, the existing antiviral treatments used in pediatric cancer patients, and the importance of vaccination. In conclusion, we reported the real-life experience of our pediatric oncology unit during the pandemic period. EXPERT OPINION Starting from the data available in literature, and our experience, showing the rarity of severe COVID-19 disease in pediatric patients with solid tumors, we recommend carefully tailoring all the oncological treatments (chemotherapy/targeted therapy/stem cell transplantation/radiotherapy). The aim is the preservation of the treatment's timing, balanced with an evaluation of possible severe COVID-19 disease.
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Affiliation(s)
- Olga Nigro
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Uberti Foppa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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15
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Solimando AG, Bittrich M, Shahini E, Albanese F, Fritz G, Krebs M. Determinants of COVID-19 Disease Severity-Lessons from Primary and Secondary Immune Disorders including Cancer. Int J Mol Sci 2023; 24:8746. [PMID: 37240091 PMCID: PMC10218128 DOI: 10.3390/ijms24108746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
At the beginning of the COVID-19 pandemic, patients with primary and secondary immune disorders-including patients suffering from cancer-were generally regarded as a high-risk population in terms of COVID-19 disease severity and mortality. By now, scientific evidence indicates that there is substantial heterogeneity regarding the vulnerability towards COVID-19 in patients with immune disorders. In this review, we aimed to summarize the current knowledge about the effect of coexistent immune disorders on COVID-19 disease severity and vaccination response. In this context, we also regarded cancer as a secondary immune disorder. While patients with hematological malignancies displayed lower seroconversion rates after vaccination in some studies, a majority of cancer patients' risk factors for severe COVID-19 disease were either inherent (such as metastatic or progressive disease) or comparable to the general population (age, male gender and comorbidities such as kidney or liver disease). A deeper understanding is needed to better define patient subgroups at a higher risk for severe COVID-19 disease courses. At the same time, immune disorders as functional disease models offer further insights into the role of specific immune cells and cytokines when orchestrating the immune response towards SARS-CoV-2 infection. Longitudinal serological studies are urgently needed to determine the extent and the duration of SARS-CoV-2 immunity in the general population, as well as immune-compromised and oncological patients.
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Affiliation(s)
- Antonio G. Solimando
- Guido Baccelli Unit of Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), Aldo Moro Bari University, 70100 Bari, Italy
| | - Max Bittrich
- Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology S. De Bellis, IRCCS Research Hospital, Via Turi 27, 70013 Castellana Grotte, Italy
| | - Federica Albanese
- Guido Baccelli Unit of Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), Aldo Moro Bari University, 70100 Bari, Italy
| | - Georg Fritz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy at the Immanuel Klinikum Bernau, Heart Center Brandenburg, 16321 Bernau, Germany
| | - Markus Krebs
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Urology and Paediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
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16
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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, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group. 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: 0.5] [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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17
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Alaeddini M, Etemad-Moghadam S. SARS-Cov-2 infection in cancer patients, susceptibility, outcome and care. Am J Med Sci 2022; 364:511-520. [PMID: 35605680 PMCID: PMC9119956 DOI: 10.1016/j.amjms.2022.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic has led to many problems in cancer patients, which in part are due to insufficient knowledge of the exact implications of the virus on these individuals. Perceptions based on known facts about previous pandemics and coronaviruses might not agree with actual real-life experience and objective findings. We present a compilation of scientific facts and actual observations on different aspects of SARS-CoV-2 infection in cancer patients. These patients are at increased risk of viral contraction and have higher chances of severe disease/mortality. The latter is impacted by other factors and is still debated. In contrast to preliminary impressions, the benefits of anti-cancer treatments outweigh their risks and should be continued. Cancer patients generate antibodies in response to vaccination but in lower amounts than healthy people, especially those with hematologic cancers. Boosters, including third doses, have shown increased immune-responses in most patients. Vaccination should be prioritized in these individuals.
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Affiliation(s)
| | - Shahroo Etemad-Moghadam
- Corresponding author at: Shahroo Etemad-Moghadam, Dentistry Research Institute, Dental Research Centre, Ghods St, Enghelab Ave, P.O. Box: 14155-5583; Postal code: 14174, Tehran, Iran
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18
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DeWolf S, Laracy JC, Perales MA, Kamboj M, van den Brink MRM, Vardhana S. SARS-CoV-2 in immunocompromised individuals. Immunity 2022; 55:1779-1798. [PMID: 36182669 PMCID: PMC9468314 DOI: 10.1016/j.immuni.2022.09.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
Immunocompromised individuals and particularly those with hematologic malignancies are at increased risk for SARS-CoV-2-associated morbidity and mortality due to immunologic deficits that limit prevention, treatment, and clearance of the virus. Understanding the natural history of viral infections in people with impaired immunity due to underlying conditions, immunosuppressive therapy, or a combination thereof has emerged as a critical area of investigation during the COVID-19 pandemic. Studies focused on these individuals have provided key insights into aspects of innate and adaptive immunity underlying both the antiviral immune response and excess inflammation in the setting of COVID-19. This review presents what is known about distinct states of immunologic vulnerability to SARS-CoV-2 and how this information can be harnessed to improve prevention and treatment strategies for immunologically high-risk populations.
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Affiliation(s)
- Susan DeWolf
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin C Laracy
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA; Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Santosha Vardhana
- Weill Cornell Medical College, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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19
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Schwering C, Apostolidou S, Deindl P, Christner M, Knobloch JKM, Herrmann J, Kobbe R, Schulz A, Singer D, Ebenebe CU. Therapeutic Management of COVID-19 in a Pediatric Patient with Neurodegenerative CLN2 Disease and ICV-Enzyme Replacement Therapy: A Case Report. Neuropediatrics 2022; 53:381-384. [PMID: 35843218 DOI: 10.1055/s-0042-1750729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The 12 years old male patient presented here suffers from neuronal ceroid lipofuscinoses 2 (CLN2) (MIM# 204500) and receives intracerebroventricular enzyme replacement therapy (ICV-ERT) every 14 days. After the emergence of the coronavirus disease 2019 (COVID-19) pandemic, routine care of children and adolescents with rare chronic diseases has become challenging. Although, in general, children do not develop severe COVID-19, when severe acute respiratory syndrome coronavirus 2 infection was detected by polymerase chain reaction-screening examination in our CLN2 patient before hospital admission for ICV-ERT, he was regarded to be at risk. Upon diagnosis, the patient developed respiratory deterioration symptoms and was admitted to our pediatric intensive care unit to receive oxygen, remdesivir, and steroids. As far as we know, this is the first CLN2 patient receiving intraventricular enzyme therapy with COVID-19 who required intensive care treatment and specific therapy.
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Affiliation(s)
- Christoph Schwering
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sofia Apostolidou
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Deindl
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Christner
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes K-M Knobloch
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Section of Pediatric Radiology, Department of Interventional and Diagnostic Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Schulz
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chinedu Ulrich Ebenebe
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Qatawneh MA, Altarawneh M, Alhazaimeh R, Jazazi M, Jarrah O, Shorman A, Alsadah L, Mustafa M. Manifestations of COVID-19 infection in children with malignancy: A single-center experience in Jordan. World J Virol 2022; 11:321-330. [PMID: 36188736 PMCID: PMC9523322 DOI: 10.5501/wjv.v11.i5.321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/28/2022] [Accepted: 09/02/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has been the cause of a global health crisis since the end of 2019. All countries are following the guidelines and re-commendations released by the World Health Organization to decrease the spread of the disease. Children account for only 3%-5% of COVID-19 cases. Few data are available regarding the clinical course, disease severity, and mode of treatment in children with malignancy and COVID-19.
AIM To evaluate the treatment plan and outcome of children with malignancy who contracted COVID-19.
METHODS A retrospective study of the medical files of patients with malignancy who contracted COVID-19 between July 2020 and June 2021 was performed. The following data were reviewed for all patients: primary disease, laboratory data, admission ward, clinical status upon admission, disease course, treatment plan, and outcome. Eligible patients were those with malignancy who tested positive for COVID-19 by reverse transcription polymerase chain reaction.
RESULTS A total of 40 patients who had malignancy contracted COVID-19 from July 1, 2020 to June 1, 2021. Their primary diseases were as follows: 34 patients (85%) had hematological malignancies (30 had acute lymphoblastic leukemia, 2 had acute myeloblastic leukemia, and 2 had Hodgkin lymphoma), whereas 6 patients (15%) had solid tumors (2 had neuroblastoma, 2 had rhabdomyosarcoma, and 2 had central nervous system tumors). Twelve patients (30%) did not need hospitalization and underwent home isolation only, whereas twenty-eight patients (70%) required hospitalization (26 patients were admitted in the COVID-19 ward and 2 were admitted in the pediatric intensive care unit).
CONCLUSION COVID-19 with malignancy in the pediatric age group has a benign course and does not increase the risk of having severe infection compared to other children.
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Affiliation(s)
- Mousa Ahmad Qatawneh
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Moath Altarawneh
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Ruba Alhazaimeh
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Mais Jazazi
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Omaiema Jarrah
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Alaa Shorman
- Department of Neonatology, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Laila Alsadah
- Department of General Pediatrics, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Maher Mustafa
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
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21
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Patel H, McArdle A, Seaby E, Levin M, Whittaker E. The immunopathogenesis of SARS-CoV-2 infection in children: diagnostics, treatment and prevention. Clin Transl Immunology 2022; 11:e1405. [PMID: 35903804 PMCID: PMC9314314 DOI: 10.1002/cti2.1405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/21/2021] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Symptoms and outcomes for paediatric COVID-19 differ vastly from those for adults, with much lower morbidity and mortality. Immunopathogenesis drives severe outcomes in adults, and it is likely that age-related differences in both the innate and specific immune responses underlie much of the variation. Understanding the protective features of the paediatric immune system may be crucial to better elucidate disease severity in adult COVID-19 and may pave the way for novel therapeutic approaches. However, as well as uncommon cases of severe paediatric acute COVID-19, there have been children who have presented with delayed multisystem inflammation, including cardiac, gastrointestinal, skin, mucosa and central nervous system involvement. The occurrence of coronary artery aneurysms has drawn comparisons with Kawasaki Disease, but similarities with the inflammatory phase of adult acute COVID-19 have also been drawn. In this review, we summarise findings from studies investigating pre-existing immunity, cytokine profiles, innate, B-cell, antibody, T-cell and vaccine responses in children with acute COVID-19 and multisystem inflammation, compared with COVID-19 adults and controls. We further consider the relevance to therapeutics in the context of limited evidence in children and highlight key questions to be answered about the immune response of children to SARS-CoV-2.
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Affiliation(s)
- Harsita Patel
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
| | - Andrew McArdle
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
| | - Eleanor Seaby
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Genomic Informatics GroupUniversity of SouthamptonSouthamptonUK
- Translational Genomics GroupBroad Institute of MIT and HarvardCambridgeMassachusettsUSA
| | - Michael Levin
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Department of PaediatricsImperial College Healthcare NHS TrustLondonUK
| | - Elizabeth Whittaker
- Department of Infectious Disease, Section of Paediatric Infectious DiseaseImperial College LondonLondonUK
- Department of PaediatricsImperial College Healthcare NHS TrustLondonUK
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22
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Behr GG, Raphael JP, Price AP, Pandit-Taskar N. Clinical and imaging experience with COVID-19 in nonvaccinated children with cancer. Clin Imaging 2022; 90:1-4. [PMID: 35839540 PMCID: PMC9272673 DOI: 10.1016/j.clinimag.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/18/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
Children with COVID-19 fare much better than adults but less is known about children with both COVID-19 and a cancer diagnosis in terms of clinical outcome and imaging. We describe our experience with a cohort of children with COVID-19 and cancer who have undergone medical imaging. We reviewed imaging and recorded clinical data and separated this group into two subgroups - hematologic and solid malignancies. Our observational data show that 1)children with hematologic malignancies may be at higher risk for complications, including death than, those with solid tumors, 2) that pulmonary imaging in the former group more often shows abnormalities and 3) that presence of pulmonary imaging abnormalities may portend an unfavorable outcome.
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Affiliation(s)
- Gerald G Behr
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, United States of America.
| | - Joseph P Raphael
- Weill-Cornell Medical Center, New York, NY, United States of America
| | - Anita P Price
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, United States of America
| | - Neeta Pandit-Taskar
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY, United States of America
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23
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COVID-19, Mucormycosis and Cancer: The Triple Threat-Hypothesis or Reality? J Pers Med 2022; 12:jpm12071119. [PMID: 35887616 PMCID: PMC9320339 DOI: 10.3390/jpm12071119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 01/09/2023] Open
Abstract
COVID-19 has been responsible for widespread morbidity and mortality worldwide. Invasive mucormycosis has death rates scaling 80%. India, one of the countries hit worst by the pandemic, is also a hotbed with the highest death rates for mucormycosis. Cancer, a ubiquitously present menace, also contributes to higher case fatality rates. All three entities studied here are individual, massive healthcare threats. The danger of one disease predisposing to the other, the poor performance status of patients with all three diseases, the impact of therapeutics for one disease on the pathology and therapy of the others all warrant physicians having a better understanding of the interplay. This is imperative so as to effectively establish control over the individual patient and population health. It is important to understand the interactions to effectively manage all three entities together to reduce overall morbidity. In this review article, we search for an inter-relationship between the COVID-19 pandemic, emerging mucormycosis, and the global giant, cancer.
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24
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López-Martinez B, Blanco-Rodríguez G, Parra-Ortega I, Ramirez-Martinez CE, Villasis-Keever MA, Miranda-Novales MG, Klünder-Klünder M, De la Rosa Zamboni D, Villa Guillen M, Nieto-Zermeño J, Garduño-Espinosa J, Zurita-Cruz JN. Screening for COVID-19 in Children Undergoing Elective Invasive Procedures. Indian J Pediatr 2022; 89:651-656. [PMID: 34677802 PMCID: PMC8531893 DOI: 10.1007/s12098-021-03959-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To report the frequency of asymptomatic infection with SARS-CoV-2 in pediatric patients undergoing invasive medical procedures in a tertiary pediatric hospital. METHODS From June to October 2020, a SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) test was performed for all pediatric patients scheduled to undergo an elective invasive procedure. None of the patients was symptomatic. The cycle threshold (Ct) values of the ORF1ab gene were recorded for all patients. RESULTS A total of 700 patients were screened for SARS-CoV-2 infection. The median age was 5.7 y old. In total, 46.6% (n = 326) of the patients were male, and 53.4% (n = 374) were female. The most common underlying diseases were hemato-oncological (25.3%), gastrointestinal (24.9%), and genitourinary (10.3%). The main scheduled surgical-medical procedures were surgical treatment for acquired congenital diseases, biopsy sampling, local therapy administration, organ transplantation, and the placement of central venous catheters, among others. The SARS-CoV-2 rRT-PCR test was positive in 9.4% (66), and the median Ct value was 35.8. None of the patients developed COVID-19. CONCLUSIONS The frequency of asymptomatic SARS-CoV-2 infection was detected in less than 10% of pediatric patients scheduled to undergo an elective invasive procedure in a tertiary hospital. This frequency is higher than those in reports from different countries.
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Affiliation(s)
- Briseida López-Martinez
- Auxiliary Diagnostic Services, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Gerardo Blanco-Rodríguez
- Thoracic Surgery and Endoscopy Service, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Israel Parra-Ortega
- Auxiliary Diagnostic Services, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Cesar Emmanuel Ramirez-Martinez
- Thoracic Surgery and Endoscopy Service, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Miguel Angel Villasis-Keever
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, México
| | - Maria Guadalupe Miranda-Novales
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, México
| | - Miguel Klünder-Klünder
- Medical Research Direction, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Daniela De la Rosa Zamboni
- Epidemiology Services, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Monica Villa Guillen
- Medical Director, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Jaime Nieto-Zermeño
- Medical Director, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Juan Garduño-Espinosa
- Hospital Director, Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Mexico City, Mexico
| | - Jessie Nallely Zurita-Cruz
- Facultad de Medicina, Universidad Nacional Autónoma de México, Hospital Infantil de México Federico Gómez, Mexico City, 06720, Mexico.
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25
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Favorable outcome of SARS-CoV-2 infection in pediatric hematology oncology patients during the second and third pandemic waves in Italy: a multicenter analysis from the Infectious Diseases Working Group of the Associazione Italiana di Ematologia e Oncologia Pediatrica (AIEOP). Ann Hematol 2022; 101:1843-1851. [PMID: 35726104 PMCID: PMC9208706 DOI: 10.1007/s00277-022-04884-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022]
Abstract
COVID-19 has a mild clinical course with low mortality rate in general pediatric population, while variable outcomes have been described in children with cancer. Infectious diseases working party of the AIEOP collected data on the clinical characteristics and outcomes of SARS-CoV-2 infections in pediatric oncology/hematology patients from April 2020 to May 2021, including the second and the third waves of the pandemic in Italy. Factors potentially associated with moderate, severe, or critical COVID-19 were analyzed. Of the 153 SARS-Cov2 infections recorded, 100 were asymptomatic and 53 symptomatic. The course of COVID-19 was mild in 41, moderate in 2, severe in 5, and critical in 5 children. A total of 40.5% of patients were hospitalized, ten requiring oxygen support and 5 admitted to the intensive care unit. Antibiotics and steroids were the most used therapies. No patient died due to SARS-CoV-2 infection. Infections occurring early (< 60 days) after the diagnosis of the underlying disease or after SCT were associated to moderate, severe, and critical disease compared to infections occurring late (> 60 days) or during maintenance therapy. In the patients on active chemotherapy, 59% withdrew the treatment for a median of 15 days. SARS-CoV-2 presented a favorable outcome in children with cancer in Italy during the pandemic. Modification of therapy represents a major concern in this population. Our findings suggest considering regular chemotherapy continuation, particularly in patients on maintenance therapy or infected late after the diagnosis.
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26
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Campbell JI, Dubois MM, Savage TJ, Hood-Pishchany MI, Sharma TS, Petty CR, Lamb GS, Nakamura MM, Pediatric COVID-19 US Registry †. Comorbidities Associated with Hospitalization and Progression Among Adolescents with Symptomatic Coronavirus Disease 2019. J Pediatr 2022; 245:102-110.e2. [PMID: 35240138 PMCID: PMC8883759 DOI: 10.1016/j.jpeds.2022.02.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify subgroups likely to benefit from monoclonal antibody and antiviral therapy by evaluating the relationship between comorbidities and hospitalization among US adolescents with symptomatic coronavirus disease 2019 (COVID-19). STUDY DESIGN We analyzed the relationship between presence of comorbidities and need for hospitalization within 28 days of COVID-19 diagnosis for adolescents aged 12-17 years listed in the Pediatric COVID-19 US registry, a multicenter retrospective cohort of US pediatric patients with COVID-19. Comorbidities assessed included obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). We used multivariable logistic regression to determine race/ethnicity-adjusted associations between comorbidities and hospitalization. RESULTS A total of 1877 patients met our inclusion criteria, of whom 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. In a race/ethnicity-adjusted model, the following comorbidities were independently associated with increased odds of hospitalization: SCD (aOR, 6.9; 95% CI, 3.0-15.9), immunocompromising condition (aOR, 6.4; 95% CI, 3.8-10.8), obesity (aOR, 3.2; 95% CI, 2.1-4.9), diabetes (aOR, 3.0; 95% CI, 1.4-6.2), neurologic disease (aOR, 2.8; 95% CI, 1.8-4.3), and pulmonary disease (excluding mild asthma) (aOR, 1.9; 95% CI, 1.2-3.1). Heart disease and CKD were not independently associated with hospitalization. CONCLUSIONS SCD, immunocompromising conditions, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma) were associated with hospitalization for symptomatic COVID-19. Adolescents with acute COVID-19 and these comorbidities should be prioritized for consideration of therapy to avert hospitalization.
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Affiliation(s)
- Jeffrey I. Campbell
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Melanie M. Dubois
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Timothy J. Savage
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - M. Indriati Hood-Pishchany
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tanvi S. Sharma
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA; and
| | - Gabriella S. Lamb
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mari M. Nakamura
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA,Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, MA,Reprint requests: Mari M. Nakamura, MD, MPH, Antimicrobial Stewardship Program, Boston Children's Hospital, 300 Longwood Ave, Mailstop BCH 3052, Boston, MA 02115
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27
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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: 22] [Impact Index Per Article: 7.3] [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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28
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Dominguez-Rojas JÁ, Vásquez-Hoyos P, Pérez-Morales R, Monsalve-Quintero AM, Mora-Robles L, Diaz-Diaz A, Torres SF, Castro-Dajer Á, Cabanillas-Burgos LY, Aguilera-Avendaño V, Cantillano-Quintero EM, Camporesi A, Agulnik A, Mukkada S, Alvarado-Gamarra G, Rojas-Soto N, Mendieta-Zevallos AL, Tello-Pezo MV, Vásquez-Ponce L, Lasso-Palomino RE, Pérez-Arroyave MC, Trujillo-Honeysberg M, Mesa-Monsalve JG, Pardo González CA, López Cubillos JF, Gonzalez-Dambrauskas S, Coronado-Munoz A. Association of Cancer Diagnosis and Therapeutic Stage With Mortality in Pediatric Patients With COVID-19, Prospective Multicenter Cohort Study From Latin America. Front Pediatr 2022; 10:885633. [PMID: 35592840 PMCID: PMC9110860 DOI: 10.3389/fped.2022.885633] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Children with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population. Methods This study is a multicenter, prospective cohort study conducted at 12 hospitals from 6 Latin American countries (Argentina, Bolivia, Colombia, Ecuador, Honduras and Peru) from April to November 2021. Patients younger than 14 years of age that had an oncological diagnosis and COVID-19 or multisystemic inflammatory syndrome in children (MIS-C) who were treated in the inpatient setting were included. The primary exposure was the diagnosis and treatment status, and the primary outcome was mortality. We defined "new diagnosis" as patients with no previous diagnosis of cancer, "established diagnosis" as patients with cancer and ongoing treatment and "relapse" as patients with cancer and ongoing treatment that had a prior cancer-free period. A frequentist analysis was performed including a multivariate logistic regression for mortality. Results Two hundred and ten patients were included in the study; 30 (14%) died during the study period and 67% of patients who died were admitted to critical care. Demographics were similar in survivors and non-survivors. Patients with low weight for age (<-2SD) had higher mortality (28 vs. 3%, p = 0.019). There was statistically significant difference of mortality between patients with new diagnosis (36.7%), established diagnosis (1.4%) and relapse (60%), (p <0.001). Most patients had hematological cancers (69%) and they had higher mortality (18%) compared to solid tumors (6%, p= 0.032). Patients with concomitant bacterial infections had higher mortality (40%, p = 0.001). MIS-C, respiratory distress, cardiovascular symptoms, altered mental status and acute kidney injury on admission were associated with higher mortality. Acidosis, hypoxemia, lymphocytosis, severe neutropenia, anemia and thrombocytopenia on admission were also associated with mortality. A multivariate logistic regression showed risk factors associated with mortality: concomitant bacterial infection OR 3 95%CI (1.1-8.5), respiratory symptoms OR 5.7 95%CI (1.7-19.4), cardiovascular OR 5.2 95%CI (1.2-14.2), new cancer diagnosis OR 12 95%CI (1.3-102) and relapse OR 25 95%CI (2.9-214). Conclusion Our study shows that pediatric patients with new onset diagnosis of cancer and patients with relapse have higher odds of all-cause mortality in the setting of COVID-19. This information would help develop an early identification of patients with cancer and COVID-19 with higher risk of mortality.
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Affiliation(s)
- Jesus Ángel Dominguez-Rojas
- Pediatric Critical Care, Hospital Edgardo Rebagliati Martins, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Lima, Peru
| | - Pablo Vásquez-Hoyos
- Pediatric Critical Care, Hospital de San Jose, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Bogota, Colombia
- Research Division, Department of Pediatrics, Fundacion Universitatia de Ciencias de la Salud–FUCS, Bogota, Colombia
| | - Rodrigo Pérez-Morales
- Pediatric Critical Care, HOMI Fundacion Hospital Pediatrico La Misericordia, Bogota, Colombia
| | | | | | - Alejandro Diaz-Diaz
- Pediatric Infectious Diseases, Hospital Pablo Tobon Uribe y Hospital General de Medellin, Medellin, Colombia
| | - Silvio Fabio Torres
- Pediatric Critical Care, Hospital Universitario Austral Pilar, Buenos Aires, Argentina
| | | | | | | | | | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sheena Mukkada
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Giancarlo Alvarado-Gamarra
- Pediatrics, Hospital Edgardo Rebagliati Martins, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Perú
| | | | | | | | - Liliana Vásquez-Ponce
- Research Center “Medicina de Precisión, ” Facultad de Medicina, Universidad de San Martín de Porres, Lima, Perú
| | | | | | | | | | | | | | - Sebastián Gonzalez-Dambrauskas
- Specialized Pediatric Critical Care (CIPe), Casa de Galicia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Medical School, Pediatric Critical Care, Pereira Rossell Medical Center (UCIN-CHPR), Universidad de la República, Montevideo, Uruguay
| | - Alvaro Coronado-Munoz
- Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, United States
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COVID-19 in Children with Cancer and Continuation of Cancer-Directed Therapy During the Infection. Indian J Pediatr 2022; 89:445-451. [PMID: 34378149 PMCID: PMC8354680 DOI: 10.1007/s12098-021-03894-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the experience with COVID-19 in children with cancer at the largest tertiary-cancer care and referral center in India. METHODS This study is a single tertiary center experience on COVID-19 in children with cancer and continuation of cancer-directed therapy in them. Children ≤ 15 y on active cancer treatment detected with COVID-19 until September 15th, 2020 were prospectively followed up in the study. Patients were managed in accordance with well-laid guidelines. Treatment was continued for children with COVID-19 who were clinically stable and on intensive treatment for various childhood cancers. RESULTS One hundred twenty-two children (median age 8 y; range 1-15 y, male:female 1.7:1) with cancer were diagnosed with COVID-19. Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%), and 6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35, and 60 d from diagnosis of COVID-19, respectively. Scheduled risk-directed intravenous chemotherapy was delivered in 70 (90.9%) of 77 children on active systemic treatment with a median delay of 14 d (range 0-48 d) and no increased toxicities. All-cause mortality rate was 7.4% (n = 9) and COVID-19 related mortality rate was 4.9% (n = 6). One hundred-fifteen (94.2%) children with COVID-19 did not require any form of respiratory support during the course of infection. CONCLUSIONS COVID-19 was not a major deterrent for the continuation of active cancer treatment despite persistent RT-PCR positivity. The long-term assessment of treatment adaptations requires further prospective follow-up and real-time addressal.
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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: 21] [Impact Index Per Article: 7.0] [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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Müller J, Szűcs-Farkas D, Szegedi I, Csóka M, Garami M, Tiszlavicz LG, Hauser P, Kriván G, Csanádi K, Ottóffy G, Nagy B, Kiss C, Kovács G. Clinical Course of COVID-19 Disease in Children Treated With Neoplastic Diseases in Hungary. Pathol Oncol Res 2022; 28:1610261. [PMID: 35431663 PMCID: PMC9008132 DOI: 10.3389/pore.2022.1610261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/01/2022] [Indexed: 12/25/2022]
Abstract
We report on children with cancer in Hungary suffering from COVID-19, surveying a 13-months-long period of time. We performed a retrospective clinical trial studying the medical documentation of children treated in seven centers of the Hungarian Pediatric Oncology-Hematology Group. About 10% of children admitted to tertiary hemato-oncological centers for anti-neoplastic treatment or diagnosis for de novo malignancies were positive for SARS-CoV-2 infection. Nearly two-thirds of the infected patients were asymptomatic or had only mild symptoms but showed seropositivity by 1–4.5 months after positive PCR. One third of the SARS-CoV-2-positive children were hospitalized due to symptomatic COVID-19. Five children required antiviral treatment with remdesivir. One child was referred to the intensive care unit, requiring intubation and mechanical ventilation. Delay in the scheduled anti-cancer treatment did not exceed 2 weeks in the majority (89%) of cases. There was only one patient requiring treatment deferral longer than a month. There was no COVID-19-related death in patients under 18 years of age, and nor was multisystem inflammatory syndrome diagnosed. In conclusion, SARS-CoV-2 infection did not represent an untoward risk factor among children with cancer in Hungary.
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Affiliation(s)
- Judit Müller
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Dóra Szűcs-Farkas
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - István Szegedi
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Monika Csóka
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Miklós Garami
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | | | - Péter Hauser
- Haematology/Oncology and Pediatric Bone Marrow Transplantation Unit, Child Health Centre, Borsod-Abauj-Zemplen County Hospital, Miskolc, Hungary
| | - Gergely Kriván
- Pediatric Bone Marrow Transplantation Department, South-Pest Centrum Hospital, Budapest, Hungary
| | - Krisztina Csanádi
- Hemato-Oncology Unit, Heim Pal Children's Hospital, Budapest, Hungary
| | - Gábor Ottóffy
- Department of Pediatrics, University of Pecs, Pecs, Hungary
| | - Béla Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csongor Kiss
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Kovács
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
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Ilinca AP, Dakhallah N, Souza AM, Liu J, Bérubé S, Brossard J, Vézina C, Pelland-Marcotte MC, Santiago R, Tran TH. Clinical characteristics and outcomes of SARS-CoV-2 infection in pediatric oncology patients in the province of Quebec. Pediatr Blood Cancer 2022; 69:e29572. [PMID: 35084108 DOI: 10.1002/pbc.29572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/09/2023]
Affiliation(s)
- André P Ilinca
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Nawar Dakhallah
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Amalia M Souza
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Jessica Liu
- Division of Pediatric Hematology-Oncology, CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Samuel Bérubé
- Division of Pediatric Hematology-Oncology, CHUL, Université Laval, Quebec City, Québec, Canada
| | - Josée Brossard
- Division of Pediatric Hematology-Oncology, CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Vézina
- Division of Pediatric Hematology-Oncology, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | | | - Raoul Santiago
- Division of Pediatric Hematology-Oncology, CHUL, Université Laval, Quebec City, Québec, Canada
| | - Thai Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
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Chhabra S, Dabas A, Mittal R, Goel N, Chowdhary RR, Batra S, Singh A, Gera R. Retrospective review of severe acute respiratory syndrome coronavirus-2 infection in children with acute leukemia from a tertiary care hospital in Northern India. Clin Exp Pediatr 2022; 65:150-151. [PMID: 34844398 PMCID: PMC8898614 DOI: 10.3345/cep.2021.01158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Suhail Chhabra
- Department of Pediatrics VMMC and Safdarjung Hospital New Delhi, India
| | - Aditya Dabas
- Department of Pediatrics VMMC and Safdarjung Hospital New Delhi, India
| | - Richa Mittal
- Department of Pediatrics VMMC and Safdarjung Hospital New Delhi, India
| | - Neha Goel
- Department of Pediatrics VMMC and Safdarjung Hospital New Delhi, India
| | | | - Satyendra Batra
- Department of Pediatrics VMMC and Safdarjung Hospital New Delhi, India
| | - Amitabh Singh
- Department of Pediatrics VMMC and Safdarjung Hospital New Delhi, India
| | - Rani Gera
- Department of Pediatrics VMMC and Safdarjung Hospital New Delhi, India
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Guzman BV, Elbel B, Jay M, Messito MJ, Curado S. Age-dependent association of obesity with COVID-19 severity in paediatric patients. Pediatr Obes 2022; 17:e12856. [PMID: 34581027 PMCID: PMC8646488 DOI: 10.1111/ijpo.12856] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Limited research has addressed the obesity-COVID-19 severity association in paediatric patients. OBJECTIVE To determine whether obesity is an independent risk factor for COVID-19 severity in paediatric patients and whether age modifies this association. METHODS SARS-CoV-2-positive patients at NYU Langone Health from 1 March 2020 to 3 January 2021 aged 0-21 years with available anthropometric measurements: weight, length/height and/or body mass index (BMI). Modified log-Poisson models were utilized for the analysis. Main outcomes were 1) hospitalization and 2) critical illness (intensive care unit [ICU] admission). RESULTS One hundred and fifteen of four hundred and ninety-four (23.3%) patients had obesity. Obesity was an independent risk factor for critical illness (adjusted risk ratio [ARR] 2.02, 95% CI 1.17 to 3.48). This association was modified by age, with obesity related to a greater risk for critical illness in adolescents (13-21 years) [ARR 3.09, 95% CI 1.48 to 6.47], but not in children (0-12 years). Obesity was not an independent risk factor for hospitalization for any age. CONCLUSION Obesity was an independent risk factor for critical illness in paediatric patients, and this association was modified by age, with obesity related to a greater risk for critical illness in adolescents, but not in children. These findings are crucial for patient risk stratification and care.
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Affiliation(s)
- Benedict Vincent Guzman
- NYU Langone Comprehensive Program on ObesityNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Brian Elbel
- NYU Langone Comprehensive Program on ObesityNYU Grossman School of MedicineNew YorkNew YorkUSA,Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA,NYU Wagner Graduate School of Public ServiceNew YorkNew YorkUSA
| | - Melanie Jay
- NYU Langone Comprehensive Program on ObesityNYU Grossman School of MedicineNew YorkNew YorkUSA,Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA,Department of MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Mary Jo Messito
- NYU Langone Comprehensive Program on ObesityNYU Grossman School of MedicineNew YorkNew YorkUSA,Department of PediatricsNYU Grossman School of Medicine, Bellevue Hospital CenterNew YorkNew YorkUSA
| | - Silvia Curado
- NYU Langone Comprehensive Program on ObesityNYU Grossman School of MedicineNew YorkNew YorkUSA,Department of Cell BiologyNYU Grossman School of MedicineNew YorkNew YorkUSA
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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: 17] [Impact Index Per Article: 5.7] [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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36
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Verma C, Taneja K, Mahajan A. COVID-19 in Pediatric Oncology Patients: Clinical Course and Outcomes from a Tertiary Care Center in North India. Indian J Pediatr 2022; 89:207. [PMID: 34741258 PMCID: PMC8571009 DOI: 10.1007/s12098-021-03987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Chandrika Verma
- Department of Pediatric Hematology and Oncology, Indraprastha Apollo Hospital, New Delhi, 110076, India
| | - Kushagra Taneja
- Department of Pediatric Hematology and Oncology, Indraprastha Apollo Hospital, New Delhi, 110076, India.
| | - Amita Mahajan
- Department of Pediatric Hematology and Oncology, Indraprastha Apollo Hospital, New Delhi, 110076, India
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Rahmadhan MA, Parenrengi MA, Suryaningtyas W. A Case Report of Pediatric Germinoma With SARS-CoV-2: Lessons Learned From an Academic Tertiary Referral Hospital in Asian COVID Epicentrum. Int J Surg Case Rep 2022; 91:106774. [PMID: 35070644 PMCID: PMC8762814 DOI: 10.1016/j.ijscr.2022.106774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patients often present with one or more pre-existing underlying chronic diseases that will affect their prognoses and mortality. A study revealed that the majority of children with SARS-CoV-2 infection presented with either no or a single symptom. Meanwhile, multiple other studies reported of more severe diseases in SARS-CoV-2 infected children with brain tumor and/or cancer as a whole. Case report The patient was a 15-year-old male who was referred to our hospital with complaints of vomiting, headache, and signs of worsening right hemiparesis. Initial MRI suggested of a high-grade astrocytoma and hydrocephalus, but a subtotal tumor resection and external ventricular drainage gave light to a histopathological examination conclusive of germinoma. After adhering to radiotherapy and recovering well, the patient fell into unconsciousness 9 months later and tested positive for SARS-CoV-2 infection. The patient deteriorated on the third day of admission with respiratory failure, shock, arrythmias, fever, and increased d-dimer. After multiple attempts stabilization with ventilatory, defibrillator, and medical support, the patient deceased at the 6th day of admission. Discussion Cancer patients with COVID-19 have been reported to have relatively higher mortality rate when compared to the non-infected patients. Moreover, malignancies were also reported to increase the risk of developing more severe disease in children. Although rare, patients may develop a condition called multisystem inflammatory syndrome in children (MIS-C), which is a state of hyperinflammatory and severe illness temporally associated with COVID-19 infection. No observations have been evident in indicating the influence of COVID-19 on the neurological state of the patient, but we believe that it may be reasonable to not yet exclude the possibility of it of exacerbating the CNS malignancy our patient suffered from. Conclusion Children with intracranial brain tumor infected by SARS-CoV-2 may fall into a worse condition with poor prognosis, exacerbated by severe acute respiratory distress and the need for breathing support in intensive care unit. Multidisciplinary tumor boards have to convene regularly, including through call-conferences and telemedicine platforms.
Patient with history of resection of tumor germinoma Covid status of the patient Mortality of the patient caused by covid status Complications of the patient that cannot over come
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Affiliation(s)
- Mustaqim Apriyansa Rahmadhan
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - M Arifin Parenrengi
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Wihasto Suryaningtyas
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
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38
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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: 1.0] [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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Kumar A, Baghmar S, Mehta P, Tiwari P, Kumar L, Bakhshi S, Agarwal A, Gupta I, Trikha A, Bhatnagar S, Gogia A, Malik PS, Sahoo RK, Rastogi S, Pramanik R, Batra A, Pushpam D, Sharma CK, Sharma V, Kataria B, Goyal K, Samaga S, Bothra SJ, Sharma A. Characteristics & outcomes of cancer patients with COVID-19: A multicentre retrospective study from India. Indian J Med Res 2022; 155:546-553. [PMID: 36348601 PMCID: PMC9807197 DOI: 10.4103/ijmr.ijmr_1703_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background & objectives High mortality has been observed in the cancer population affected with COVID-19 during this pandemic. We undertook this study to determine the characteristics and outcomes of cancer patients with COVID-19 and assessed the factors predicting outcome. Methods Patients of all age groups with a proven history of malignancy and a recent diagnosis of SARS-CoV-2 infection based on nasal/nasopharyngeal reverse transcriptase (RT)-PCR tests were included. Demographic, clinical and laboratory variables were compared between survivors and non-survivors groups, with respect to observed mortality. Results Between May 11 and August 10, 2020, 134 patients were included from the three centres and observed mortality was 17.1 per cent. The median age was 53 yr (interquartile range 39-61 yr) and thirty four patients (25%) were asymptomatic. Solid tumours accounted for 69.1 per cent and breast cancer was the most common tumour type (20%). One hundred and five patients (70.5%) had received chemotherapy within the past four weeks and 25 patients (19.3%) had neutropenia at presentation. On multivariate analysis, age [odds ratio (OR) 7.99 (95% confidence interval [CI] 1.18-54.00); P=0.033], haemoglobin [OR 6.28 (95% CI 1.07-37.04); P=0.042] neutrophil-lymphocyte ratio [OR 12.02 (95% CI 2.08-69.51); P=0.005] and baseline serum albumin [OR 18.52 (95% CI 2.80-122.27); P=0.002], were associated with higher mortality. Recent chemotherapy, haematological tumours type and baseline neutropenia did not affect the outcome. Interpretation & conclusions Higher mortality in moderate and severe infections was associated with baseline organ dysfunction and elderly age. Significant proportion of patients were asymptomatic and might remain undetected.
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Affiliation(s)
- Akash Kumar
- Department of Medical Oncology, National Cancer Institute, New Delhi, India,For correspondence: Dr Akash Kumar, Department of Medical Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail:
| | - Saphalta Baghmar
- Department of Medical Oncology, BL Kapur Hospital, New Delhi, India
| | - Prashant Mehta
- Department of Medical Oncology/Hematology/BMT, Asian Institute of Medical Sciences, Gurugram, Haryana, India
| | - Priya Tiwari
- Department of Medical Oncology, Artemis Hospital, Gurugram, Haryana, India
| | - Lalit Kumar
- Department of Medical Oncology, New Delhi, India
| | | | - Amit Agarwal
- Department of Medical Oncology, New Delhi, India
| | - Ishaan Gupta
- Department of Medical Oncology/Hematology/BMT, Asian Institute of Medical Sciences, Gurugram, Haryana, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia & Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, New Delhi, India
| | | | | | | | | | - Atul Batra
- Department of Medical Oncology, New Delhi, India
| | - Deepam Pushpam
- Department of Onco-Anaesthesia & Palliative Medicine, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, New Delhi, India
| | - Chitresh K Sharma
- Department of Surgical Oncology, National Cancer Institute, New Delhi, India
| | - Vinod Sharma
- Department of Medical Oncology, National Cancer Institute, New Delhi, India
| | - Babita Kataria
- Department of Medical Oncology, National Cancer Institute, New Delhi, India
| | - Kapil Goyal
- Department of Medical Oncology, New Delhi, India
| | - Shreyas Samaga
- Department of Biochemical Engineering & Biotechnology, Institute of Technology, New Delhi, India
| | - Sneha J Bothra
- Department of Medical Oncology/Hematology/BMT, Asian Institute of Medical Sciences, Gurugram, Haryana, India
| | - Atul Sharma
- Department of Medical Oncology, New Delhi, India
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Bansal M, Sachdev M, Chakraborty S, Dua V. Second wave of COVID-19 – Not a matter of great concern for pediatric hematologist/oncologist. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [PMCID: PMC8760525 DOI: 10.1016/j.phoj.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic and is giving rise to a serious health threat globally. SARS-CoV-2 infection ranges from asymptomatic carrier state to severe illness requiring intensive care unit (ICU) management. It is postulated that with COVID-19 infection, children are less prone to develop severe symptoms as compared with adults. The data on immunocompromised children affected with COVID-19 infection is limited and not many publications are there on the effects of 2nd wave of COVID-19 infection in pediatric hematology/oncology patients till date. Methods Retrospective data analysis of patients under the age of 18 years with underlying hematological and oncological conditions including those who underwent stem cell transplantation. All SARS-CoV-2-positive cases were included in the study. Results In our experience during second wave, 17 patients were found to be positive for SARS-CoV-2 with a male: female ratio of 2.4: 1 and median age of 8 years (range 1 – 18 years). Out of these 17 patients, 10 (58.8%) patients required hospital admission whereas the remaining were managed at home. Only 1 patient required ventilatory support and there was no mortality. Conclusion Though the number of pediatric patients with COVID-19 infection were more during the second wave but majority had mild to moderate symptoms and were easily managed.
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Wang Z, Shen Y, Jin R, Yu H, Zhou F, Xu J, Qiu Y, Wang L, Wu X. The Status of Pediatric Patients With Hematologic Malignancy During COVID-19 Pandemic in Wuhan City, China. J Pediatr Hematol Oncol 2022; 44:e127-e133. [PMID: 33625077 DOI: 10.1097/mph.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/30/2021] [Indexed: 01/08/2023]
Abstract
Data regarding the epidemiologic characteristics and clinical features of pediatric hematologic patients are limited in this corona virus disease 2019 (COVID-19) crisis. We investigated the status of 113 pediatric hematologic patients in Wuhan union hospital during the COVID-19 pandemic from January 23 to March 10, 2020. All the patients had routine blood and biochemical examination, as well as chest computed tomography scans, and the nucleic acid, immunoglobulin G-immunoglobulin M combined antibodies tests for SARS-CoV-2. After admission, all patients were single-room isolated for 5 to 7 days. The results showed that only 1 (0.88%) child with leukemia was confirmed to have SARS-CoV-2 infection and 15 (13.2%) children were considered as suspected cases. Comparing to the nonsuspected patients, the suspected cases had lower white blood cell count, hemoglobin level, neutrophil count, serum calcium ion level and serum albumin concentration, as well as higher levels of C-reactive protein. All the suspected cases were ruled out of SARS-CoV-2 infection by twice negative tests for the virus. Therefore, the incidence of SARS-CoV-2 infection in hematologic malignancy children was low during the COVID-19 pandemic in China. COVID-19 got early detected and the virus spread out in the ward was effectively blocked by increasing test frequency and using single-room isolation for 5 to 7 days after admission.
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Affiliation(s)
| | | | | | - Hui Yu
- Departments of Pediatrics
| | | | | | | | - Lin Wang
- Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tolunay O, Çelik Ü, Arslan I, Tutun B, Özkaya M. Evaluation of Clinical Findings and Treatment Results of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Center Experience. Front Pediatr 2022; 10:848379. [PMID: 35359885 PMCID: PMC8960421 DOI: 10.3389/fped.2022.848379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of the study is to evaluate the clinical findings and treatment results of COVID-19 in pediatric cancer patients. STUDY DESIGN The study was designed as a single-center retrospective observational study. Pediatric cancer patients with COVID-19 admitted to the University of Health Sciences Adana City Training and Research Hospital pediatric COVID wards from October 2020 to October 2021 were included. Clinical data and demographic characteristics were retrieved from patient files. RESULTS A total of 45 pediatric cancer patients diagnosed with COVID-19 were included in the study. The mean age of the patients was 8.68 ± 5.16 years (range 1.5-17.5), 62.2% were men, 37.8% were Turkish citizens, and 62.2% were Syrian refugees. A total of 41 patients (91.1%) had leukemia/lymphoma, while 4 (8.9%) had solid tumors. The most common symptoms were fever (66.7%), respiratory (35.6%), and gastrointestinal symptoms (17.8%). Disease severity was evaluated as mild in 46.7%, moderate in 44.4%, and severe in 8.9% of patients. Patients presented with lymphopenia (88.9%), thrombocytopenia (73.3%), anemia (71.1%), and neutropenia (62.2%). Mean hospital length of stay was 15.18 ± 10.34 (range 6-62) days overall and 9.5 ± 2.39 (range 2 to 28) days in the PICU. Intensive care unit admission rate was 8.9%, and mortality rate was 4.4%. Median viral shedding period was 21 days (range 7-52). CONCLUSIONS Our study reveals that the mortality rate, length of hospital stay, and the need for intensive care of pediatric cancer patients with COVID-19 are higher than those of healthy children. Prospective studies with larger sample sizes are needed to further evaluate the clinical findings and treatment results of COVID-19 in pediatric cancer patients.
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Affiliation(s)
- Orkun Tolunay
- Department of Pediatrics, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Ümit Çelik
- Department of Pediatric Infectious Diseases, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Ilknur Arslan
- Department of Pediatrics, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Bugra Tutun
- Department of Pediatrics, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Merve Özkaya
- Department of Pediatrics, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Seshachalam A, Saju SV, Raju H, Rathnam K, Janarthinakani M, Prasad K, Patil C, Anoop P, Reddy N, Anumula S, Golamari K, Bodepudi S, Danthala M, Malipatil B, Senthilkumar G, Niraimathi K, Raman SG. Outcome of COVID-19 in Indian patients with cancer: A multicenter, retrospective study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_212_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Totadri S, Srinivasan HN, Joseph LL, Boddu D, Suresh Kochath P, Moorthy M, Mathew LG, John RR. The Unique Balancing Act of Managing Children With Cancer and COVID-19 Infection: A Single Center Experience From South India. J Pediatr Hematol Oncol 2022; 44:e287-e292. [PMID: 33769391 DOI: 10.1097/mph.0000000000002148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
Children with cancer are vulnerable to severe infections. Balancing the intensive treatment of cancer, with the potential risk of coronavirus disease-2019 (COVID-19) related morbidity and mortality is a unique challenge. Children with cancer testing positive for severe acute respiratory syndrome coronavirus 2 virus by reverse-transcription polymerase chain reaction at our center were studied. Thirty-seven children tested positive for COVID-19 during the study period. The severity of the illness was mild, moderate, severe, and critical in 10 (27%), 13 (35%), 12 (32%), and 2 (5%) patients, respectively. Of the 14 patients with a severe/critical illness, 2 had oncological emergencies, 4 had dengue co-infection, and 1 had an inguinal bacterial abscess. All patients were discharged in a stable condition. Modification of the treatment protocol was performed in 11 (33%) of 33 patients who were on active treatment for cancer. There was a median delay of 32.5 days to administer the next cycle of chemotherapy in patients who acquired COVID-19 during cancer treatment. Six of 7 patients who were retested after 14 days remained positive by reverse-transcription polymerase chain reaction. Children with cancer with COVID-19 recover with good supportive care. Curative chemotherapy can be administered safely with appropriate modifications in children with cancer with COVID-19.
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Affiliation(s)
| | | | - Leenu L Joseph
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
| | - Deepthi Boddu
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
| | | | - Mahesh Moorthy
- Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni G Mathew
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
| | - Rikki R John
- Paediatric Haematology-Oncology Unit, Department of Paediatrics
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Romeih M, Mahrous MR, Shalby L, Khedr R, Soliman S, Hassan R, El-Ansary MG, Ismail A, Al Halfway A, Mahmoud A, Refeat A, Zaki I, Hammad M. Prognostic impact of CT severity score in childhood cancer with SARS-CoV-2. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8356547 DOI: 10.1186/s43055-021-00563-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background CT chest severity score (CTSS) is a semi-quantitative measure done to correlate the severity of the pulmonary involvement on the CT with the severity of the disease. The objectives of this study are to describe chest CT criteria and CTSS of the COVID-19 infection in pediatric oncology patients, to find a cut-off value of CTSS that can differentiate mild COVID-19 cases that can be managed at home and moderate to severe cases that need hospital care. A retrospective cohort study was conducted on 64 pediatric oncology patients with confirmed COVID-19 infection between 1 April and 30 November 2020. They were classified clinically into mild, moderate, and severe groups. CT findings were evaluated for lung involvement and CTSS was calculated and range from 0 (clear lung) to 20 (all lung lobes were affected). Results Overall, 89% of patients had hematological malignancies and 92% were under active oncology treatment. The main CT findings were ground-glass opacity (70%) and consolidation patches (62.5%). In total, 85% of patients had bilateral lung involvement, ROC curve showed that the area under the curve of CTSS for diagnosing severe type was 0.842 (95% CI 0.737–0.948). The CTSS cut-off of 6.5 had 90.9% sensitivity and 69% specificity, with 41.7% positive predictive value (PPV) and 96.9% negative predictive value (NPV). According to the Kaplan–Meier analysis, mortality risk was higher in patients with CT score > 7 than in those with CTSS < 7. Conclusion Pediatric oncology patients, especially those with hematological malignancies, are more vulnerable to COVID-19 infection. Chest CT severity score > 6.5 (about 35% lung involvement) can be used as a predictor of the need for hospitalization.
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Haeusler GM, Ammann RA, Carlesse F, Groll AH, Averbuch D, Castagnola E, Agyeman PK, Phillips B, Gilli F, Solopova G, Attarbaschi A, Wegehaupt O, Speckmann C, Sung L, Lehrnbecher T. SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients. Eur J Cancer 2021; 159:78-86. [PMID: 34736044 PMCID: PMC8501219 DOI: 10.1016/j.ejca.2021.09.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE There are limited data on SARS-CoV-2 (COVID-19) infection in children with cancer or after haematopoietic stem cell transplant (HSCT). We describe the severity and outcomes of SARS-COV-2 in these patients and identify factors associated with severe disease. METHODS This was a multinational, observational study of children (aged <19 years) with cancer or HSCT and SARS-CoV-2 confirmed by polymerase chain reaction. COVID-19 was classified as asymptomatic, mild, moderate, severe or critical (≥1 organ support). Exact polytomous regression was used to determine the relationship between clinical variables and disease severity. RESULTS One hundred and thirty-one patients with COVID-19 across 10 countries were identified (median age 8 years). Seventy-eight (60%) had leukaemia/lymphoma, 48 (37%) had solid tumour and five had primary immunodeficiency and HSCT. Fever (71%), cough (47%) and coryza (29%) were the most frequent symptoms. The median duration of detectable virus was 16 days (range, 1-79 days). Forty-nine patients (37%) were hospitalised for COVID-19 symptoms, and 15 (11%) required intensive care unit-level care. Chemotherapy was delayed/modified in 35% of patients. COVID-19 was asymptomatic in 32% of patients, mild in 47%, moderate in 8%, severe in 4% and critical in 9%. In 124 patients (95%), a full recovery was documented, and four (3%) died due to COVID-19. Any comorbidity (odds ratio, 2.94; 95% confidence interval [CI], 1.81-5.21), any coinfection (1.74; 95% CI 1.03-3.03) and severe baseline neutropenia (1.82; 95% CI 1.13-3.09) were independently and significantly associated with increasing disease severity. CONCLUSION Although most children with cancer had asymptomatic/mild disease, 13% had severe COVID-19 and 3% died. Comorbidity, coinfection and neutropenia may increase the risk of severe disease. Our data may help management decisions in this vulnerable population.
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Affiliation(s)
- Gabrielle M. Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia,The Paediatric Integrated Cancer Service, Parkville, Victoria State Government, Australia,Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia,Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, Australia,Corresponding author: Murdoch Children's Research Institute, Flemington Rd, Parkville, Australia
| | - Roland A. Ammann
- Paediatric Hematology and Oncology, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland,Kinderaerzte KurWerk, Burgdorf, Switzerland
| | - Fabianne Carlesse
- Paediatric Oncology Institute, GRAACC/Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Paediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Dina Averbuch
- Paediatric Infectious Disease, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
| | - Elio Castagnola
- Infectious Diseases Unit, Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Philipp K.A. Agyeman
- Paediatric Hematology and Oncology, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Bob Phillips
- Leeds Cancer Centre, Leeds Teaching Hospital, NHS Trust, Leeds, United Kingdom,Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Flávio Gilli
- Department of Paediatric Intensive Care, Centro Infantil Boldrini, Campinas, Brazil
| | - Galina Solopova
- Dmitry Rogachev Federal Scientific-Clinical Center of Children's Hematology, Oncology and Immunology, Moscow, Russia
| | - Andishe Attarbaschi
- Paediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Oliver Wegehaupt
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Paediatrics and Adolescent Medicine, Department of Paediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Center for Paediatrics and Adolescent Medicine, Department of Paediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas Lehrnbecher
- Paediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
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Johnston EE, Martinez I, Davis ES, Caudill C, Richman J, Brackett J, Dickens DS, Kahn A, Schwalm C, Sharma A, Patel PA, Bhatia S, Levine JM, Wolfson JA. SARS-CoV-2 in Childhood Cancer in 2020: A Disease of Disparities. J Clin Oncol 2021; 39:3778-3788. [PMID: 34694886 PMCID: PMC8608263 DOI: 10.1200/jco.21.00702] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Pediatric Oncology COVID-19 Case Report registry supplies pediatric oncologists with data surrounding the clinical course and outcomes in children with cancer and SARS-CoV-2. METHODS This observational study captured clinical and sociodemographic characteristics for children (≤ 21 years) receiving cancer therapy and infected with SARS-CoV-2 from the pandemic onset through February 19, 2021. The demographic and clinical characteristics of the cohort were compared with population-level pediatric oncology data (SEER). Multivariable binomial regression models evaluated patient characteristics associated with hospitalization, intensive care unit (ICU) admission, and changes in cancer therapy. RESULTS Ninety-four institutions contributed details on 917 children with cancer and SARS-CoV-2. Median age at SARS-CoV-2 infection was 11 years (range, 0-21 years). Compared with SEER, there was an over-representation of Hispanics (43.6% v 29.7%, P < .01), publicly insured (59.3% v 33.5%, P < .01), and patients with hematologic malignancies (65.8% v 38.3%, P < .01) in our cohort. The majority (64.1%) were symptomatic; 31.2% were hospitalized, 10.9% required respiratory support, 9.2% were admitted to the ICU, and 1.6% died because of SARS-CoV-2. Cancer therapy was modified in 44.9%. Hispanic ethnicity was associated with changes in cancer-directed therapy (adjusted risk ratio [aRR] = 1.3; 95% CI, 1.1 to 1.6]). Presence of comorbidities was associated with hospitalization (aRR = 1.3; 95% CI, 1.1 to 1.6) and ICU admission (aRR = 2.3; 95% CI, 1.5 to 3.6). Hematologic malignancies were associated with hospitalization (aRR = 1.6; 95% CI, 1.3 to 2.1). CONCLUSION These findings provide critical information for decision making among pediatric oncologists, including inpatient versus outpatient management, cancer therapy modifications, consideration of monoclonal antibody therapy, and counseling families on infection risks in the setting of the SARS-CoV-2 pandemic. The over-representation of Hispanic and publicly insured patients in this national cohort suggests disparities that require attention.
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Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth S Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Caroline Caudill
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Houston, TX
| | - David S Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Alissa Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph's University Medical Center, Paterson, NJ
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, Kalamazoo, MI
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Pratik A Patel
- Pediatric Hematology-Oncology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Jennifer M Levine
- Pediatric Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Julie A Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
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Pearce J, Friar S, Jigoulina G, Bate J. SARS CoV-2 Antibody Persistence During Induction Chemotherapy for Pediatric T-Cell Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2021; 43:e1258-e1259. [PMID: 33902067 DOI: 10.1097/mph.0000000000002182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Janice Pearce
- Department of Paediatric Oncology Southampton Children's Hospital
| | - Simon Friar
- Southampton Specialist Virology Centre University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Galina Jigoulina
- Department of Paediatric Oncology Southampton Children's Hospital
| | - Jessica Bate
- Department of Paediatric Oncology Southampton Children's Hospital
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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: 16] [Impact Index Per Article: 4.0] [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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Buhtoiarov IN. Acute Lymphoblastic Leukemia Diagnosis Following Infection With SARS-CoV-2: Pure Randomness or Reproducible Causation? J Pediatr Hematol Oncol 2021; 43:e1255-e1256. [PMID: 33902069 DOI: 10.1097/mph.0000000000002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ilia N Buhtoiarov
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH
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