Impact of the First Wave of COVID-19 on Pediatric Oncology and Hematology: A Report from the French Society of Pediatric Oncology

Abstract

Data regarding coronavirus disease 2019 (COVID-19) description are still limited in pediatric oncology. The French society of pediatric oncology (SFCE) initiated a study to better describe COVID-19 in patients followed in French pediatric oncology and hematology wards. All patients diagnosed with COVID-19 and followed in a SFCE center were enrolled. Data from medical records were analyzed for all patients enrolled up to the end of May 2020. Data were available for 37 patients. Thirty-one were children under 18 years of age. Nineteen patients were female. Seventeen patients had a solid tumor, 16 had a hematological malignancy and four recently underwent hematopoietic stem cell transplantation (HSCT) for non-oncological conditions. Twenty-eight patients presented symptoms, most often with fever, cough, rhinorrhea and asthenia. Ground-glass opacities were the most frequent radiological finding with abnormalities mostly bilateral and peripherally distributed. Twenty-four patients received chemotherapy a month prior to COVID-19 diagnosis. Most patients did not require hospitalization. Three patients required oxygen at the time of diagnosis. In total, five patients were admitted in an intensive care unit because of COVID-19 and one died from the disease. Children and young adults treated for a cancer and/or with a HSCT may be at risk for severe COVID-19 and should be closely monitored.

Management and Outcome of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Centre Experience from a Developing Country

“…22 Chemotherapy exposes patients to an added risk of immunosuppression and infection. Our results were similar to the SFCE results, 8 where 1/3 of our patients had combined neutropenia and lymphopenia, of whom 2/3 could be related to prior intensive chemotherapy. Lymphopenia in some adult studies have been linked to disease severity, 23 but our study and Anil et al could not link any cytopenias to COVID-19 severity.…”

“…Similar to others, we admitted most patients irrespective of COVID-19 severity to exclude other associated serious bacterial infections. 8 Our decision to admit patients was influenced by the low socioeconomic status of families and the need to monitor for clinical deterioration. Madhusoodhan et al stated that 75% of COVID-19 patients were admitted despite only 38.4% required inpatient care for COVID-19-related symptoms.…”

“…The French Society of Pediatric Oncology (SFCE) and others reported that 12-20% of their patients had presented with severe form of infection that required intensive care admission. 7,8 Preliminary reports suggested that cancer patients were at risk of increased mortality from SARS-COV-2 infection compared to the general population. 2,20 Singling out COVID-19 as the cause of mortality in oncology patients is difficult as other factors may contribute to morality risk in cancer patients.…”

“…7 The current situation mandates that chemotherapy be tailored according to the clinical scenario of each patient. 8 Studies are still ongoing in order to determine the best antiviral therapy for COVID-19. 9 Preliminary studies have touted the potential benefits of remdesivir (RDV) in patients with severe COVID-19.…”

Impact of COVID-19 on Pediatric Immunocompromised Patients

“…First, in pediatric oncology patients, the risk of death is less than adults, but appears to be higher than the general pediatric population and may be worse when compounded by certain high-risk demographics, e.g. male, obese, and older age, or in patients with hematologic malignancies 12 , 51 , 52 , 53 , 54 . In contrast to oncology patients, published cohorts of pediatric rheumatology patients, SOT, chronic kidney disease on immune suppression, and IBD reported low rates of severe complications, but the literature is less extensive in these diseases.…”