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, Tomasz Ociepa, Anna Raciborska, Agnieszka Książek, Tomasz Szczepański, Jarosław Peregud‐Pogorzelski, Maryna Krawczuk‐Rybak, Radosław Chaber, Michał Matysiak, Jacek Wachowiak, Ninela Irga‐Jaworska, Wojciech Młynarski, Bożenna Dembowska–Bagińska, Walentyna Balwierz, Agnieszka Matkowska‐Kocjan, Bernarda Kazanowska, Jan Styczyński, Marek Ussowicz
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.