Journal of Hematology & Oncology (Oct 2021)

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

  • Jadwiga Węcławek-Tompol,
  • Zuzanna Zakrzewska,
  • Olga Gryniewicz-Kwiatkowska,
  • Filip Pierlejewski,
  • Ewa Bień,
  • Agnieszka Zaucha-Prażmo,
  • Olga Zając-Spychała,
  • Anna Szmydki-Baran,
  • Agnieszka Mizia-Malarz,
  • Wioletta Bal,
  • Małgorzata Sawicka-Żukowska,
  • Agnieszka Kruk,
  • Anna Raciborska,
  • Agnieszka Książek,
  • Tomasz Szczepański,
  • Jarosław Peregud-Pogorzelski,
  • Maryna Krawczuk-Rybak,
  • Radosław Chaber,
  • Michał Matysiak,
  • Jacek Wachowiak,
  • Wojciech Młynarski,
  • Bożenna Dembowska-Bagińska,
  • Walentyna Balwierz,
  • Agnieszka Matkowska-Kocjan,
  • Bernarda Kazanowska,
  • Jan Styczyński,
  • Marek Ussowicz

DOI
https://doi.org/10.1186/s13045-021-01181-4
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 10

Abstract

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

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