SARS-CoV-2 in pediatric cancer: a systematic review

Abstract

The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan challenges pediatric oncologists in an unexpected way. We provide a comprehensive overview, which systematically summarizes and grades evidence (QoE) on SARS-CoV-2 infections in pediatric cancer patients at 1.5 years of pandemic. A systematic literature search in PubMed combined with an additional exploratory literature review in other international databases was conducted to identify studies on children (aged < 18 years) with a malignant disease and COVID-19 infections. In total, 45 reports on 1003 pediatric cancer patients with SARS-CoV-2 infections were identified out of 1397 reports analyzed. The clinical course of COVID-19 was reported mild or moderate in 358 patients (41.7%), whereas 11.1% of patients showed severe COVID-19. In 12.7% of patients, chemotherapy was postponed, whereas 19% of patients with different underlying malignancies received chemotherapy during SARS-CoV-2 infection. Twenty-five patients with SARS-CoV-2 infections died, potentially related to COVID-19.Conclusion: Despite a favorable COVID-19 outcome in most pediatric cancer patients, the morbidity is reported higher than in children without comorbidities. However, no severe COVID-19 complications were associated to the continuation of chemotherapy in some cohort studies and reports on two patients. Therefore, the risk of cancer progress or relapse due to interruption of chemotherapy has carefully to be weighed against the risk of severe COVID-19 disease with potentially fatal outcome. What is Known:• Most of pediatric patients with malignant diseases show an asymptomatic, mild or moderate clinical course of SARS-CoV-2 infection. • Current need for a basis for decision-making, whether to stop or interrupt cancer treatment in a patient infected with SARS-CoV-2, and when to continue chemotherapy. What is New:• Review results comprising over 1000 pediatric COVID-19 cancer patients confirm mild courses of SARS-CoV-2 infection in most patients but also show the attributable mortality is at least 10 times higher compared to reports on hospitalized children without comorbidities.• Review identifies that chemotherapy was continued despite SARS-CoV-2 positivity in 18% of patients with individual chemotherapy modification according to the clinical course of SARS-CoV-2 infection and existing comorbidities. On this basis, no severe COVID-19 complications were associated to the continuation of chemotherapy in several cohort studies and two case reports.

SARS-CoV-2 Infection in Filipino Children: An Interim Report from the SALVACION Registry

“…13 A systematic review by Schlage, et al on COVID-19 and pediatric cancer reported that COVID-19 infection in pediatric cancer patients resulted in severe disease in only a minority of patients; however, despite a milder course, mortality rate was higher than in children with no comorbidities, with deaths attributable to either COVID-19 complications or cancer progression. 20 In another study by Williams, et al, cardiac comorbidities were most common in children with severe and critical COVID-19. 21 Among MIS-C cases, obesity was the most common comorbidity, consistent with the report of Hoste, et al 16 With obesity being associated with a chronic subclinical inflammatory status, it is hypothesized that COVID-19 infection triggers a greater hyperinflammatory response and higher endothelial, macrophage and adipocyte activation, leading to considerably elevated inflammatory markers and more severe complications.…”

COVID-19-Associated Pulmonary Fungal Infection among Pediatric Cancer Patients, a Single Center Experience

“…In the Abi Vijenthira study, adult patients with hematologic malignancy and COVID-19 had a 34% risk of death, whereas pediatric patients had a 4% risk of death [ 5 ]. In a systematic review by Schlage and colleagues about COVID-19 in pediatric cancer comprising over 1000 patients, the attributable mortality was at least 10 times higher compared to the reports on hospitalized children without comorbidities [ 2 ]. Published data from our center regarding COVID-19 mortality was reported to be 15% while in the current study, CAPFI was associated with higher mortality rate among pediatric cancer patients as failure was reported in 38% of patients, with 20% of patients’ deaths attributable to CAPA [ 3 ].…”

“…The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has markedly affected pediatric cancer patients. Children with malignancies were assumed to be at higher risk for severe coronavirus disease 2019 (COVID-19) due to their immunocompromised state; however, many studies reported that most pediatric cancer patients experience only mild to moderate COVID-19 infection [ 1 , 2 , 3 ]. Among patients with confirmed COVID-19, the frequency of cancer diagnosis has been reported to be 2% [ 4 ], with a 34% mortality risk rate [ 5 ].…”

Supportive care in pediatric acute myeloid leukemia:Expert-based recommendations of the NOPHO-DB-SHIP consortium

“…The benefit of all these various treatments in hematology patients deserves further studies. The drug availability in each country and the expertise of infectious disease experts should be considered when determining the treatment for pediatric AML with COVID19 [52][53][54].…”