COVID‐19 – Impact on Childhood Haematology Patients

Wolfs, Tom F. W.; Attarbaschi, Andishe; Balduzzi, Adriana; Bernardo, Maria Ester; Bomken, Simon; Bourquin, Jean-Pierre; Dufour, Carlo; Gennery, Andrew R.; Grainger, John D.; Hasle, Henrik; Hrušák, Ondřej; Izraeli, Shai; Méchinaud, Françoise; Trka, Jan; Vormoor, Josef

doi:10.1097/hs9.0000000000000465

Cited by 12 publications

(15 citation statements)

References 28 publications

(49 reference statements)

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“…In contrast, studies in paediatric immunocompromised patients showed that T-cell lymphopenia was associated with fewer severe morbidities such as acute respiratory distress syndrome and hyperinflammation (20). We speculate that severe lymphopenia and cGvHD treatment with 0.8 mg/kg/day prednisone and ECP had a protective effect with an attenuated inflammatory response in our patient.…”

Section: Discussioncontrasting

confidence: 64%

“…An observational Centre for International Blood and Marrow Transplant Research (CIBMTR) study included 318 HSCT recipients with a SARS-CoV-2 diagnosis and confirmed the association of the time interval from HSCT <12 months and age with higher risk of mortality. Of note, a mild SARS-CoV-2 disease course was observed in 49% of patients (20). Varma et al found that concomitant steroid treatment was an additional risk factor for poor outcome of SARS-CoV-2 infection in adult HSCT patients (21).…”

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2 Infection and Active, Multiorgan, Severe cGVHD After HSCT for Adolescent ALL: More Luck Than Understanding? A Case Report

et al. 2022

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Graft-vs. -host disease (GvHD) is a serious and complex immunological complication of haematopoietic stem cell transplantation (HSCT) and is associated with prolonged immunodeficiency and non-relapse mortality. Standard treatment of chronic GvHD comprises steroids in combination with other immunosuppressive agents. Extracorporeal photopheresis (ECP), with its immunomodulatory mechanism, is applied as part of steroid-sparing regimens for chronic GvHD. Immunocompromised, chronically ill patients are at particular risk of severe disease courses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. T-cell immunity in SARS-CoV-2 infection is well-described but the role of the humoral immune responses is not fully understood. This case report describes a moderate course of SARS-CoV-2 infection in a patient <9 months after HSCT who was suffering from active, severe, chronic GvHD treated with prednisone and ECP. Following HSCT from a matched unrelated donor to cure acute lymphoblastic leukaemia, the 25-year-old male patient experienced multiple infectious complications associated with cytopenia, B-cell dyshomeostasis and autoantibody production followed by development of severe chronic GvHD thereafter at day +212. The steroid-sparing treatment plan consisted of supportive care, topical treatment, prednisone and ECP. He was diagnosed with SARS-CoV-2 infection at day +252, experiencing loss of smell and taste as well as a cough. The patient's oxygen saturation was between 94 and 97% on room air, and computed tomography images showed evolution of typical of SARS-CoV-2 infiltrates. In addition to cytopenia and immune dyshomeostasis, laboratory tests confirmed macrophage activating syndrome, transaminitis and Epstein-Barr virus viraemia. At that time, anti-SARS-CoV-2 monoclonal antibodies were not available in Austria and remdesivir seemed contraindicated. Surprisingly, despite severe lymphopenia the patient developed SARS-CoV-2-specific antibodies within 15 days, which was followed by clearance of SARS-CoV-2 and EBV with resolution of symptoms. Thereafter, parameters of immune dysregulation such as lymphopenia and B-cell dyshomeostasis, the latter characterised by elevated CD21low B cells and autoantibody expression, normalised. Moreover, we observed complete response of active chronic GvHD to treatment.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Infection and Active, Multiorgan, Severe cGVHD After HSCT for Adolescent ALL: More Luck Than Understanding? A Case Report

et al. 2022

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“…No deaths, however, were strictly related to the infection ( 116 ). In general, the relatively small size of the cancer pediatric population does not allow assessment of whether being affected by a hemato-oncological disease is a risk factor for a severe pattern in case of exposure to SARS-CoV-2 ( 117 ). If the underlying disease has any impact, it might be counterbalanced by the protective effect of the young age as ultimately shown by the mild or asymptomatic infection of most reports ( 118 – 122 ).…”

Section: Resultsmentioning

confidence: 99%

COVID-19 in Immunosuppressed Children

et al. 2021

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Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression—if not associated with other elements of fragility—do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.

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“…Until now, COVID-19 has been found to affect children less commonly than adults, and to cause a milder course in children [ 2 – 4 ]. Furthermore, published reports confirm little direct effect of COVID-19 on pediatric oncological patients [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…As stated by Wolfs et al [ 6 ], an important potential risk for cancer patients is delayed diagnosis and treatment during this pandemic. Delays in diagnosis could be due to decreased access of patients to their primary physicians, overuse of telemedicine-based-practice, avoidance of families to seek medical care due to fear of infection, cancellation of presumed non-essential laboratory and imaging tests, and cognitive biases resulting in physician misdiagnosis due to the pandemic.…”

Section: Introductionmentioning

confidence: 99%

Delayed diagnosis and treatment of children with cancer during the COVID-19 pandemic

et al. 2021

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Background COVID-19, the novel coronavirus has caused a global pandemic affecting millions of people around the world. Although children, including children with cancer, have been found to be affected less commonly and less severely than adults, indirect effects of the pandemic on the diagnosis and treatment of children with cancer have been less described. Methods A survey was performed in the four largest tertiary pediatric hematology-oncology medical centers in Israel. Clinical and laboratory data were collected from the medical files of patients diagnosed or treated with cancer during April–October 2020. Results Seventeen patients are described, who had a significant delay in diagnosis or treatment of cancer. These represent approximately 10% of all pediatric cancer diagnosed during the study period in these centers. A main cause of delay was fear of exposure to COVID-19 (fears felt by the patient, parent, physician, or decision-makers at the institution; or the implementation of national guidelines). Delays also resulted from co-infection with COVID-19 and the attribution of the oncologic symptoms to the infection. In addition, treatment was delayed of patients already diagnosed with cancer, due to COVID-19 infection detected in the patient, a family member, or a bone marrow donor. Conclusion Fear from the COVID-19 pandemic may result in delayed diagnosis and treatment of children with cancer, which may carry a risk to dismal prognosis. It is crucial that pediatricians and patients alike remember that other diseases still prevail and must be thought of and treated in a timely fashion.

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COVID‐19 – Impact on Childhood Haematology Patients

Cited by 12 publications

References 28 publications

SARS-CoV-2 Infection and Active, Multiorgan, Severe cGVHD After HSCT for Adolescent ALL: More Luck Than Understanding? A Case Report

SARS-CoV-2 Infection and Active, Multiorgan, Severe cGVHD After HSCT for Adolescent ALL: More Luck Than Understanding? A Case Report

COVID-19 in Immunosuppressed Children

Delayed diagnosis and treatment of children with cancer during the COVID-19 pandemic

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