For most of the pandemic, COVID-19 has been mild in children. Has this been true for children with underlying health conditions, in particular cancer?
Although the delta variant has changed how COVID-19 impacts populations of all ages, SARS- CoV-2 rarely caused serious illness in healthy children . For children and teenagers with cancer, however, severe illness is more likely when caused by respiratory viruses, such as COVID-19. A recent investigation sought to find the clinical course and outcomes of COVID-19 in children and teenagers who have cancer.1
The investigators used data from 131 institutions in 45 countries to create the Global Registry of COVID-19 in Childhood Cancer to included de-identified data related to laboratory-confirmed infection of COVID-19 in children and adolescents aged <19 years who had either cancer or had received a hematopoietic stem-cell transplantation. Data for oncological diagnosis, clinical course, cancer therapy details, and demographics were collected.
There were a total of 1500 patients included in the study, of which 1319 had complete 30 days of follow-up. A severe or critical infection occurred in 259 patients and 50 died from a cause that is attributable to the COVID-19 infection. Alterations in cancer-directed therapy were made for 609 patients who were receiving active oncological treatment. Several factors were linked to severe or critical illness, following a multivariable analysis, included absolute lymphocyte count of 300 or less cells per mm3 (odds ratio (OR) 2.5 [95% CI, 1.8–3.4]; p<0.0001), absolute neutrophil count of 500 or less cells per mm3 (OR 1.8 [95% CI, 1.3–2.4]; p=0.0001), and intensive treatment (OR 1.8 [95% CI, 1.3–2.3]; World Bank low-income or lower-middle-income (OR 5.8 [95% CI 3.8–8.8]; p<0.0001) and upper-middle-income (OR 1.6 [95% CI, 1.2–2.2]; p=0.0024) country status; and age 15–18 years (OR 1.6 [95% CI, 1.1–2.2]; p=0.013). A primary diagnosis of other hematological malignancies (OR 0.5 [95% CI, 0.3–0.8]; p=0.0088), at least 1 COVID-19 symptom at the time of presentation (OR 1.8 [95% CI, 1.3–2.4]; p=0.0002), the presence of at least 1 comorbidity (OR 1.6 [95% CI, 1.1–2.3]; p=0.020), and upper-middle-income country status (OR 0.5 [95% CI, 0.3–0.7]; p=0.0004).
The investigators concluded that among pediatric patients with cancer and COVID-19, severe and critical illness happened in 1 in 5 patients. Deaths occurred at a higher rate than had been reported in the general pediatric population. The data from the study could help with the creation of clinical guidelines for COVID-19 in children.
1. Mukkada S, Bhakta N, Chantada G, et al. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. The Lancet Oncology. August 26, 2021. Epub ahead of print. doi:10.1016/S1470-2045(21)00454-X