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)

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.

Risk factors for a severe disease course in children with SARS-COV-2 infection following hematopoietic cell transplantation in the pre-Omicron period: a prospective multinational Infectious Disease Working Party from the European Society for Blood and Marrow Transplantation group (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH) study

“…Higher rate of T-cell depletion and comorbidities in these children could probably contribute to this, and shall be assessed in the multivariate analysis. In a multicentre Italian study, infections occurring early (<60 days) after the diagnosis or after SCT were associated with higher risk of moderate/severe/critical disease [ 30 ]. We, however, did not observe higher rate of severe disease course during the early pre-HCT period.…”

Outcomes of Coronavirus Disease 2019 Infection in Children and Adolescents With Cancer in Canada: Population-based Study and Systematic Review

“…The withdrawal or delay of cancer treatment, after COVID-19 infection, has been the practice of many pediatric cancer centers during the pandemic. 10,[13][14][15]18,26,27 Our results add to emerging evidence that the continuance of cancer-directed therapy is safe, particularly for those who are asymptomatic or with mild symptoms. 16,20,33,42,43 The long-term impact of treatment delays incurred due to the COVID-19 pandemic is not yet known.…”

“…[29][30][31] Data evaluating outcomes in children with cancer and COVID-19 infection have been more disparate, as evidenced by outcome variability in our systematic review. 9,10,[13][14][15][16][17][18][21][22][23][24][25][26] In our cohort, 10 patients (11.6%) required hospital admission within 4 weeks of COVID-19 infection, 80% of these were admitted with febrile neutropenia. Symptoms arising due to coinfection with a non-COVID-19 pathogen, were a common reason for admission in our cohort, as reported by Haeusler et al 17 Though 2 patients required ICU admission, neither was admitted to ICU for the management of COVID-19 symptoms.…”

“…7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] COVID-19 infection has also resulted in the delay or withdrawal of cancer-directed therapy. 7,[13][14][15][16][17]26,27 To date, data for Canadian childhood cancer patients with COVID-19 have not been reported apart from 4 pediatric centers in Quebec. 15 The primary objectives of this study were to describe patient characteristics at the time of COVID-19 infection and outcomes of infection; including interruptions to cancer therapy, hospitalization, and associated mortality, in children with cancer treated at 12 Canadian pediatric oncology centers between January 2020 and December 2021.…”

The Impact of COVID-19 on Pediatric Malignancy Diagnosis and Treatment: Never the Same but Lessons Learned

“…These data showed that only a handful of patients had a severe or critical illness from the virus. More importantly, this report showed that infections occurring early on in the oncologic diagnosis had a worse outcome as compared to those infections occurring later on during the maintenance phase suggesting the importance of continuing chemotherapy, especially in those children on maintenance therapy [ 9 ]. In a systematic review by Schlage et al that included 45 articles with over one thousand pediatric oncology patients with COVID-19, 41.7% had mild or moderate symptoms, 11.1% of patients showed severe COVID-19 symptoms, and 2.9% of patients with COVID-19 died, potentially due to complications related to COVID-19 [ 4 ].…”