Remdesivir during induction chemotherapy for newly diagnosed paediatric acute lymphoblastic leukaemia with concomitant SARS‐CoV‐2 infection

Abstract

The COVID‐19 pandemic potentially makes treatment of acute leukaemia more difficult. Most induction chemotherapy regimens for acute leukaemia lead to extended periods of cytopaenia and immunosuppression rendering patients vulnerable to opportunistic infections. As with many aspects of SARS‐CoV‐2, there is no universally accepted way of treating patients who present with acute leukaemia and associated infection.

Clinical presentations and outcomes of children with cancer and COVID‐19: A systematic review

“…In 29 studies ( n = 177 patients), 8,11–14,16–39 there was a mention of the type of test used to detect SARS‐CoV‐2. Among the 177 patients in these studies, PCR‐based tests were used to establish the diagnosis in 142 (one was also positive on CBNAAT) and antibody‐based tests in 23 (the type of test used was not mentioned for 12 patients in the study by Montoya et al 18 …”

“…In 196 patients (31 studies), 5,10–39 there was a mention about the type of malignancy, and 120 (53%) had hematological malignancies, and 76 (47%) had solid tumors. In studies that reported remission status (18 studies), 23 patients out of 47 were in remission from the underlying malignancy 10,11,14,20–26,29–37 (Table 1).…”

“…Twenty‐six studies ( n = 184 patients) reported about clinical symptoms 5,10–14,16–18,20–28,30–36,38 . Amongst the 184 patients included in these studies, fever was the commonest symptom in 77 (41.4%), followed by cough (12.3%).…”

“…Gastrointestinal symptoms were present in 17, and skin involvement was mentioned for three patients. In 30 studies ( n = 209 patients), 5,8,10–18,20–38 the severity of the symptoms was reported. Sixty‐three patients had no symptoms, 38 had mild symptoms, nine had moderate symptoms, and 20 (9.6%) had severe symptoms.…”

COVID-19 and remdesivir in pediatric patients: the invisible part of the iceberg

“…5 In a 5-year-old child who received remdesivir during induction chemotherapy for newly diagnosed pediatric acute lymphoblastic leukemia with concomitant SARS-CoV-2 infection, remdesivir was well tolerated with no adverse effects, except for the expected increase in ALT secondary to induction chemotherapy. 7 Just in case, using the Child-Pugh score (total bilirubin, albumin, INR, and the presence of ascites and encephalopathy) and pediatric end-stage liver disease (PELD) score (age, bilirubin, albumin, INR, and history of growth failure) for dose adjustment in COVID-19 patients with hepatic impairment should be considered by clinicians. On the other hand, according to a case series, a total of seven doses of remdesivir, which were well tolerated by stable creatinine and liver function tests throughout therapy, were successfully administered to a 19-day-old full-term infant.…”