Tocilizumab in a child with acute lymphoblastic leukaemia and COVID-19-related cytokine release syndrome

Velasco, Pablo; Moreno, Lucas; Heredia, Cristina Díaz de; Rivière, Jacques G.; Palacín, Pere Soler

doi:10.1016/j.anpede.2020.05.002

Cited by 8 publications

(16 citation statements)

References 6 publications

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“…After screening the full text of each of the studies, 23 studies were excluded, and 33 studies were included in the final analysis (Figure 1). 5,8–39 …”

Section: Resultsmentioning

confidence: 99%

“…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 …”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

“…Among 24 studies including 102 patients 5,10,13–17,20–25,27–35,37 for whom information was available on the phase of chemotherapy/hematopoietic stem cell transplant (HSCT) status, 34 were on the intensive phase of chemotherapy, 13 were on low‐dose chemotherapy, six had completed treatment, and 17 post HSCT (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Meena

Gupta

Tanwar

et al. 2021

Pediatric Blood & Cancer

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Information regarding the novel coronavirus disease (COVID‐19) in pediatric oncology is limited. We conducted a systematic review of the available published literature on children with cancer affected by COVID‐19. The last date of the study search was October 20, 2020, and 33 studies comprising 226 children were included for the final analysis. Data were extracted in a predefined data collection form, and the variables were extracted and analyzed. Patients with hematological malignancies were more in number. Males and children on intensive treatment were more frequently affected. Fever was the commonest symptom. The disease was asymptomatic/mild in 48% and severe in 9.6%. Consolidation, peribronchial cuffing, and consolidation with ground glass opacities were the common imaging findings. Hydroxychloroquine was the most frequently used drug for COVID‐19. About 10% of children required intensive care, and about 32% had oxygen requirements. The percentage of children who died due to COVID‐19 was 4.9%. The severity, morbidity, and mortality of COVID‐19 in pediatric oncology were more compared to the general pediatric population. This information can help in risk stratification for the management of COVID‐19.

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“…After screening the full text of each of the studies, 23 studies were excluded, and 33 studies were included in the final analysis (Figure 1). 5,8–39 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Meena

Gupta

Tanwar

et al. 2021

Pediatric Blood & Cancer

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Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

2021

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An association between a novel pediatric hyperinflammatory condition and SARS-CoV-2 was recently published and termed pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome (in children) (MIS(-C)). We performed a systematic review and describe the epidemiological, clinical, and prognostic characteristics of 953 PIMS-TS/MIS(-C) cases in 68 records. Additionally, we studied the sensitivity of different case definitions that are currently applied. PIMS-TS/MIS(-C) presents at a median age of 8 years. Epidemiological enrichment for males (58.9%) and ethnic minorities (37.0% Black) is present. Apart from obesity (25.3%), comorbidities are rare. PIMS-TS/MIS(-C) is characterized by fever (99.4%), gastrointestinal (85.6%) and cardiocirculatory manifestations (79.3%), and increased inflammatory biomarkers. Nevertheless, 50.3% present respiratory symptoms as well. Over half of patients (56.3%) present with shock. The majority of the patients (73.3%) need intensive care treatment, including extracorporal membrane oxygenation (ECMO) in 3.8%. Despite severe disease, mortality is rather low (1.9%). Of the currently used case definitions, the WHO definition is preferred, as it is more precise, while encompassing most cases. Conclusion : PIMS-TS/MIS(-C) is a severe, heterogeneous disease with epidemiological enrichment for males, adolescents, and racial and ethnic minorities. However, mortality rate is low and short-term outcome favorable. Long-term follow-up of chronic complications and additional clinical research to elucidate the underlying pathogenesis is crucial. What is Known: • A novel pediatric inflammatory syndrome with multisystem involvement has been described in association with SARS-CoV-2. • To date, the scattered reporting of cases and use of different case definitions provides insufficient insight in the full clinical spectrum, epidemiological and immunological features, and prognosis. What is New: • This systematic review illustrates the heterogeneous spectrum of PIMS-TS/MIS(-C) and its epidemiological enrichment for males, adolescents, and racial and ethnic minorities. • Despite its severe presentation, overall short-term outcome is good. • The WHO MIS definition is preferred, as it is more precise, while encompassing most cases. Supplementary Information The online version contains supplementary material available at 10.1007/s00431-021-03993-5.

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Multisystem Inflammatory Syndrome in Children Associated with COVID-19 Infection: A Comprehensive Review

Meza-Contreras

Galdos-Bejar

Escalante-Kanashiro

2022

J Pediatr Intensive Care

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The Multisystem Inflammatory Syndrome in Children (MIS-C) is a postinfectious syndrome associated with coronavirus disease 2019 (COVID-19) disease in children. The aim of this study is to conduct a thorough review to assist health care professionals in diagnosis and management of this complication of COVID-19 disease in children. A thorough systematic review was conducted through an on-line search based on MIS-C with the primary focus on epidemiology, clinical characteristics, diagnosis, pathophysiology, management, and long-term follow-up. This syndrome is characterized by an exaggerated and uncontrolled release of proinflammatory cytokines involving dysfunction of both innate and adaptive immunity. In this review, a summary of observational studies and case reports was conducted, in which we found that MIS-C generates multiple-organ failure frequently presenting with hemodynamic instability further characterized by Kawasaki-like symptoms (such as persistent high fever, polymorphic rash, and bilateral conjunctivitis) and predominance of gastrointestinal and cardiovascular signs and symptoms. Keys to effective management involve early diagnosis, timely treatment and re-evaluation following hospital discharge. Diagnosis is marked by significant elevation of inflammatory biomarkers, laboratory evidence of COVID-19 infection or history of recent exposure, and absence of any other plausible explanation for the associated signs, symptoms, and presentation. Management includes hemodynamic stabilization, empiric antibiotic therapy (de-escalation if cultures and polymerase chain reaction studies indicate no bacterial co-infection), immunomodulatory therapy (methylprednisolone, intravenous immunoglobulin, anakinra, tocilizumab, siltuximab, Janus kinase inhibitors, tumor necrosis factor-α inhibitors), antivirals (remdesivir), and anticoagulation (acetylsalicylic acid, unfractionated or low-molecular-weight heparin or new oral anticoagulants). In addition, we identified poor prognostic risk factors to include concurrent comorbidities, blood-component consumption and marrow suppression (lymphopenia, thrombocytopenia), depletion of homeostatic components (hypoalbuminemia), and marked evidence of a hyperinflammatory response to include elevated values of ferritin, C-reactive protein, and D-dimer. MIS-C constitutes a postinfectious syndrome characterized by a marked cytokine storm, characterized by fever, bilateral conjunctivitis, and multiple organ dysfunction. Promoting future research and long-term follow-up will be essential for the development of guidelines and recommendations leading to effective identification and management of MIS-C.

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Tocilizumab in a child with acute lymphoblastic leukaemia and COVID-19-related cytokine release syndrome

Cited by 8 publications

References 6 publications

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

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

Multisystem inflammatory syndrome in children related to COVID-19: a systematic review

Multisystem Inflammatory Syndrome in Children Associated with COVID-19 Infection: A Comprehensive Review

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