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Foxworthy B, Dai C, Davis EC, Xavier AC, Brackett J, Dickens D, Kahn A, Martinez I, Sharma A, Schwalm C, Foley J, Wilkes J, Bhatia S, Levine JM, Johnston EE, Wolfson JA. COVID-19 infection in children, adolescents, and young adults with Down syndrome and hematologic malignancies. Pediatr Blood Cancer 2024; 71:e31082. [PMID: 38804869 DOI: 10.1002/pbc.31082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/15/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Children, adolescents, and young adults (CAYAs) with Down syndrome (DS) and hematologic malignancies are particularly vulnerable to infections and related complications. There are limited data regarding COVID-19 infections in this group. We aimed to understand the clinical course of COVID-19 in this population. METHODS This observational study leverages the de-identified clinical and sociodemographic data captured by the Pediatric Oncology COVID-19 Case Report Registry (POCC) regarding CAYAs with cancer and COVID-19. We evaluated CAYAs (≤21 years at COVID-19 infection) with hematologic malignancies and COVID-19 reported from April 1, 2020 to May 2, 2023, comparing those with and without DS. Using multivariable logistic regression, we examined rates of hospitalization, intensive care unit (ICU) admission, respiratory support, and changes in cancer-directed therapy. RESULTS Among 1408 CAYAs with hematologic malignancies, 55 had DS (CAYA-DS). CAYA-DS had higher rates of hospitalization, ICU admission, and respiratory support (p < .001) than CAYAs without DS. Similarly, multivariable analyses found higher odds of hospitalization (odds ratio [OR] = 2.8, 95% confidence interval [CI]: 1.5-5.1), ICU admission (OR = 4.2, 95% CI: 1.9-9.1), and need for respiratory support (OR = 4.2, 95% CI: 2.0-8.8) among CAYA-DS. Modifications to cancer-directed therapy were more common among CAYA-DS when related to neutropenia (p = .001), but not when unrelated to neutropenia (p = .88); CAYA-DS did not have higher odds of changes to cancer-directed therapy (OR = 1.20, 95% CI: 0.7-2.1). CONCLUSIONS We identify CAYA-DS with hematologic malignancies as a vulnerable subpopulation at greater risk for severe COVID-19 infection. This can inform conversations with patients and families regarding therapeutic and preventive measures, as well as the risks and benefits of modifying chemotherapy in the setting of COVID-19.
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Affiliation(s)
- Blake Foxworthy
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chen Dai
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Ana C Xavier
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - David Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Alissa Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Bronson Methodist Hospital, Kalamazoo, Michigan, USA
| | - Jessica Foley
- Pediatric Hematology-Oncology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Jennifer Wilkes
- Department of Pediatrics, Division of Cancer and Blood Disorders, University of Washington, Seattle, Washington, USA
| | - Smita Bhatia
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer M Levine
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Emily E Johnston
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie A Wolfson
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Wolfson JA, Davis ES, Saha A, Martinez I, McCall D, Kothari P, Brackett J, Dickens DS, Kahn AR, Schwalm C, Sharma A, Richman J, Cuglievan B, Bhatia S, Dai C, Levine JM, Johnston EE. Adolescents and young adults with cancer: the clinical course of COVID-19 infections. J Natl Cancer Inst 2024; 116:1366-1373. [PMID: 38627241 DOI: 10.1093/jnci/djae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/20/2023] [Accepted: 04/05/2024] [Indexed: 08/09/2024] Open
Abstract
Adolescents and young adults (ie, individuals aged 15-39 years, known as AYAs) with cancer face unique vulnerabilities yet remain underrepresented in clinical trials, including adult registries of COVID-19 in cancer (AYAs: 8%-12%). We used the Pediatric Oncology COVID-19 Case Report to examine the clinical course of COVID-19 among AYAs with cancer. The Pediatric Oncology COVID-19 Case Report collects deidentified clinical and sociodemographic data regarding individuals aged from birth to 39 years with cancer (37%) and COVID-19 from more than 100 institutions. Between April 1, 2020, and November 28, 2023, 191 older AYAs (individuals 22-39 years of age) and 640 younger AYAs (individuals 15-21 years of age) were captured. Older AYAs were less often hospitalized (P < .001), admitted to the intensive care unit (P = .02), and required respiratory support (P = .057). In multivariable analyses, older AYAs faced 80% lower odds of intensive care unit admission but 2.3-times greater odds of changes to cancer-directed therapy. Unvaccinated patients had 5.4-times higher odds of intensive care unit admission. Among AYAs with cancer, the COVID-19 course varies by age. These findings can inform oncology teams directing COVID-19 management and prevention in AYA patients with cancer.
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Affiliation(s)
- Julie A Wolfson
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth S Davis
- Department of Surgery, Boston University/Boston Medical Center, Boston, MA, USA
| | - Aniket Saha
- Pediatric Hematology-Oncology, Prisma Health Upstate, Bi-Lo Charities Children's Cancer Center, and Greenville Health System, Greenville, SC, USA
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David McCall
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | - Prachi Kothari
- Pediatric Hematology-Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - David S Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Alissa R Kahn
- Pediatric Hematology/Oncology, Department of Pediatrics, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Joshua Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Branko Cuglievan
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | - Smita Bhatia
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer M Levine
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Emily E Johnston
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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Zhang N, Wang Z, Li H, Chen K, Wang HS, Shao JB, Jiang SY, Zhai XW, Jiang H. Immunophenotype of lymphocytes and real-world outcome of COVID-19 infection in children with hematology and oncology. BMC Cancer 2024; 24:538. [PMID: 38678181 PMCID: PMC11056048 DOI: 10.1186/s12885-024-12262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Patients with immunocompromise were suspected to encounter a high risk for severe coronavirus disease 2019 (COVID-19) infection on early period; however, data is lacking nowadays and immune response remain unclear. METHODS In this retrospective study, internet questionnaire survey and medical records were acquired in pediatric hematology oncology patients. Clinical severity, immunological characteristics, and outcomes were analyzed from December 1, 2022 to January 31, 2023 at the 3rd year of pandemic in China. RESULTS A total of 306 patients were included, with 21 patients (6.9%) asymptomatic, 262 (85.6%) mild severity, 17 (5.6%) moderate severity, 5 (1.6%) severe severity, and 1 (0.3%) critical severity. Seventy-eight (25.5%) patients were on intensive chemotherapy, and 32.0% children were on maintenance chemotherapy. Delays in cancer therapy occurred in 86.7% patients. Univariable analysis revealed active chemotherapy (P < 0.0001), long duration of symptom (P < 0.0001), low lymphocytes count (P = 0.095), low CD3 + and CD8 + T cell count (P = 0.013, P = 0.022), high percentage of CD4 + TCM (P = 0.016), and low percentage of transitional B cells (P = 0.045) were high risk factors for severe COVID-19 infection. Cox regression model showed that the absolute lymphocytes count (P = 0.027) and long duration of symptom (P = 0.002) were the independent factors for severity. Patients with CD8 + dominant and B cell depletion subtype wasn't related with severity, but had higher percentage of CD8 + effector memory T cells (TEM) and terminally differentiated effector memory T cells (TEMRA) (P < 0.001, P < 0.001), and a longer COVID-19 duration (P = 0.045). CONCLUSION The severity was relatively mild in children with immunodeficiencies in the third year of COVID-19 pandemic. Low lymphocyte count and long duration of symptom were the independent risk factors with COVID-19 severity. Delays in cancer care remain a major concern and the long outcome is pending.
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Affiliation(s)
- Na Zhang
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, 200040, Shanghai, China
| | - Zhen Wang
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, 200040, Shanghai, China
| | - Hong Li
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, 200040, Shanghai, China
| | - Kai Chen
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, 200040, Shanghai, China
| | - Hong-Sheng Wang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Jing-Bo Shao
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, 200040, Shanghai, China
| | - Sha-Yi Jiang
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, 200040, Shanghai, China
| | - Xiao-Wen Zhai
- Department of Hematology and Oncology, Children's Hospital of Fudan University, Shanghai, China
| | - Hui Jiang
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, 200040, Shanghai, China.
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Wolfset N, Azar ARP, Phillips CA, Stein M, Rheingold SR, Heimall J, Elgarten CW. Coronavirus Disease 2019 mRNA Vaccination Appears Safe in Pediatric Patients With Hypersensitivity to Polyethylene Glycolated Escherichia coli L-asparaginase. J Pediatr Hematol Oncol 2024; 46:e202-e204. [PMID: 38181327 PMCID: PMC11046694 DOI: 10.1097/mph.0000000000002805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/05/2023] [Indexed: 01/07/2024]
Abstract
Polyethylene glycol-asparaginase (PEGAsp) is an established component of acute leukemia therapy. Hypersensitivity reactions to PEGAsp occur in 10% to 15% of patients, with polyethylene glycol suggested as the antigenic culprit. As coronavirus disease 2019 (COVID-19) mRNA vaccines contain polyethylene glycol, the safety of administration of these vaccines to patients with prior PEGAsp hypersensitivity has been questioned. Between December 21, 2020 and March 3, 2022, 66 patients with acute leukemia and PEGAsp allergy received COVID-19 vaccination. No patients (0/66 0%, 95% CI: 0%-5.4%) experienced an allergic reaction to the vaccine. COVID-19 mRNA vaccination appears to be safe in pediatric and young adult patients with acute lymphoblastic leukemia with PEGAsp allergy.
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Affiliation(s)
- Nicole Wolfset
- Children’s Hospital of Philadelphia, Division of Allergy and Immunology
| | | | - Charles A. Phillips
- Children’s Hospital of Philadelphia, Division of Oncology
- Children’s Hospital of Philadelphia, Department of Biomedical and Health Informatics
| | - Madison Stein
- Children’s Hospital of Philadelphia, Division of Oncology
| | | | - Jennifer Heimall
- Children’s Hospital of Philadelphia, Division of Allergy and Immunology
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5
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Yılmaz Çelebi M, Şahinkaya Ş, Cem E, Akaslan Kara A, Özdağ E, Ayhan FY, Karakaya N, Odaman Al I, Gözmen S, Hilkay Karapınar T, Oymak Y, Bayram SN, Devrim İ. A hidden burden of disease in a specific group: Evaluation of COVID-19 seroconversion rates in pediatric patients with leukemia. Am J Infect Control 2024; 52:320-323. [PMID: 37726054 DOI: 10.1016/j.ajic.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND SARS-CoV-2, a respiratory viral disease, is thought to have a more severe course in patients with malignancy and low immune systems. METHODS This prospective single-center study was conducted at the University of Health Sciences Dr Behçet Uz Children's Hospital from September 22 to December 31, 2021. Asymptomatic COVID-19 transmission rates were assessed using SARS-CoV-2 serology in patients with leukemia who had no history of COVID-19 infection. RESULTS Among the 54 patients, 19 (35.2%) were females and 35 (64.8%) were males. The median age was 5.5 years (min 6 months, max 17 years). Forty-nine (90.5%) of the leukemia patients had acute lymphoblastic leukemia, while 5 (9.5%) had acute myeloid leukemia. Five of the 54 patients had a history of COVID-19 or contact with a positive person. SARS-CoV-2 IgG positivity was detected in 18 (36.7%) of 49 patients with no history of COVID-19 infection. DISCUSSION Leukemia patients have a high seroconversion for SARS-CoV-2 without showing any symptoms supporting the asymptomatic course of COVID-19 infection in this risk group. CONCLUSION As a result, patients with leukemia may have a high rate of COVID-19 seroconversion without showing symptoms.
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Affiliation(s)
- Miray Yılmaz Çelebi
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey.
| | - Şahika Şahinkaya
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Ela Cem
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Aybüke Akaslan Kara
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Eda Özdağ
- Department of Pediatrics, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Fahri Y Ayhan
- Department of Microbiology, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - Nurgül Karakaya
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Işık Odaman Al
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Salih Gözmen
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Tuba Hilkay Karapınar
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology and Oncology, University of Health Sciences Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Süleyman N Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
| | - İlker Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behçet Uz, Children's Hospital, İzmir, Turkey
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6
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Hashmi SK, Bodea J, Patni T, Angel S, Bhakta NH, Jeha S, Karol SE, Ribeiro RC, Rubnitz JE, Wolf J, Li Y, Pui CH, Hijano DR, Inaba H. COVID-19 in Pediatric Patients With Acute Lymphoblastic Leukemia or Lymphoma. JAMA Netw Open 2024; 7:e2355727. [PMID: 38363571 PMCID: PMC10873761 DOI: 10.1001/jamanetworkopen.2023.55727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
Importance COVID-19 in pediatric patients with acute lymphoblastic leukemia or lymphoma (ALL/LLy) has not been described in detail and may affect chemotherapy administration and long-term outcomes. Objective To describe the clinical presentation of COVID-19 and chemotherapy modifications in pediatric patients with ALL/LLy. Design, Setting, and Participants This is a retrospective case series of patients at St Jude Children's Research Hospital and its affiliate sites with newly diagnosed ALL/LLy who were treated on the Total XVII protocol (NCT03117751) between March 30, 2020, and June 20, 2022. Participants included patients aged 1 to 18 years who were receiving protocol chemotherapy. Acute symptoms and chemotherapy modifications were evaluated for 60 days after the COVID-19 diagnosis, and viral clearance, adverse events, and second SARS-CoV-2 infections were followed up during the 27-month study period. Exposures SARS-CoV-2; all patients were screened at least weekly and at symptom onset and/or after known exposure to SARS-CoV-2. Main Outcomes and Measures Description of the spectrum of COVID-19 illness and chemotherapy modifications. Results Of 308 pediatric patients, 110 (36%) developed COVID-19 at a median age of 8.2 (IQR, 5.3-14.5) years. Sixty-eight patients (62%) were male. Most patients were in the continuation/maintenance phase of chemotherapy (101 [92%]). Severe disease was rare (7 [6%]) but was associated with older age, higher white blood cell counts at ALL/LLy diagnosis, lower absolute lymphocyte counts at COVID-19 diagnosis, abnormal chest imaging findings, and SARS-CoV-2 reinfection. Rare but serious thrombotic events included pulmonary embolism and cerebral venous sinus thrombosis (n = 1 for each). No multisystem inflammatory syndrome in children or death was seen. SARS-CoV-2 reinfection occurred in 11 patients (10%) and was associated with older age and with receiving standard or high-risk vs low-risk ALL/LLy therapy. Chemotherapy interruptions occurred in 96 patients (87%) and were longer for patients with severe disease, SARS-CoV-2 reinfection, and/or a COVID-19 diagnosis during the pre-Omicron variant period vs the post-Omicron period (after December 27, 2021). Conclusions and Relevance In this case series of COVID-19 in pediatric patients with ALL/LLy, severe COVID-19 was rare, but chemotherapy administration was affected in most patients. Long-term studies are needed to establish the outcomes of COVID-19 in this population.
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Affiliation(s)
- Saman K. Hashmi
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jessica Bodea
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tushar Patni
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Savannah Angel
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Nickhill H. Bhakta
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sima Jeha
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Seth E. Karol
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Raul C. Ribeiro
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jeffrey E. Rubnitz
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yimei Li
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Diego R. Hijano
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Hiroto Inaba
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
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7
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Ruiz J, Aldewereld Z, Elgarten C. Chemotherapy Delays Due to SARS-CoV-2 Infection in Children With Leukemia or Lymphoma. JAMA Netw Open 2024; 7:e2355679. [PMID: 38363574 DOI: 10.1001/jamanetworkopen.2023.55679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Affiliation(s)
- Jenny Ruiz
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zachary Aldewereld
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Caitlin Elgarten
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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8
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Martin SD, Nziza N, Miozzo P, Bartsch Y, Farkas EJ, Kane AS, Boal LH, Friedmann A, Alter G, Yonker LM. Humoral profiling of pediatric patients with cancer reveals robust immunity following anti-SARS-CoV-2 vaccination superior to natural infection. Pediatr Blood Cancer 2023; 70:e30473. [PMID: 37249415 PMCID: PMC10321888 DOI: 10.1002/pbc.30473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Pediatric patients with cancer infected with COVID-19 may be at higher risk of severe disease and may be unable to mount an adequate response to the virus due to compromised immunity secondary to their cancer therapy. PROCEDURE This study presents immunologic analyses of 20 pediatric patients with cancer, on active chemotherapy or having previously received chemotherapy, and measures their immunoglobulin titers and activation of cellular immunity response to acute SARS-CoV-2 infection and COVID-19 vaccination compared with healthy pediatric controls. RESULTS Forty-three patients were enrolled, of which 10 were actively receiving chemotherapy, 10 had previously received chemotherapy, and 23 were healthy controls. Pediatric patients with cancer had similar immunoglobulin titers, antibody binding capacity, and effector function assay activity after vaccination against COVID-19 compared with healthy controls, though more variability in response was noted in the cohort actively receiving chemotherapy. Compared with acute infection, vaccination against COVID-19 produced superior immunoglobulin responses, particularly IgA1, IgG1, and IgG3, and elicited superior binding capacity and effector function in children with cancer and healthy controls. CONCLUSIONS Pediatric patients receiving chemotherapy and those who had previously received chemotherapy had adequate immune activation after both vaccination and acute infection compared to healthy pediatric controls, although there was a demonstrated variability in response for the patients on active chemotherapy. Vaccination against COVID-19 produced superior immune responses compared to acute SARS-CoV-2 infection in pediatric patients with cancer and healthy children, underscoring the importance of vaccination even in previously infected individuals.
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Affiliation(s)
- Samantha D Martin
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nadège Nziza
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Boston, Massachusetts, USA
| | - Pietro Miozzo
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yannic Bartsch
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Boston, Massachusetts, USA
| | - Eva J Farkas
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Abigail S Kane
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren H Boal
- Department of Pediatrics, Hematology/Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison Friedmann
- Department of Pediatrics, Hematology/Oncology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lael M Yonker
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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9
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Elgarten CW, Kairalla JA, Thompson JC, Miller TP, Wang C, Conway S, Loh ML, Raetz EA, Gupta S, Rau RE, Angiolillo A, Rabin KR, Alexander S. SARS-CoV-2 infections in patients enrolled on the Children's Oncology Group standard-risk B-cell acute lymphoblastic leukemia trial, AALL1731. EJHAEM 2023; 4:745-750. [PMID: 37601850 PMCID: PMC10435702 DOI: 10.1002/jha2.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 08/22/2023]
Abstract
Hematologic malignancy is a risk factor for severe coronavirus disease 2019 (COVID-19) in adults; however, data specific to children with leukemia are limited. High-quality infectious adverse event data from the ongoing Children's Oncology Group (COG) standard-risk B acute lymphoblastic leukemia/lymphoma (ALL/LLy) trial, AALL1731, were analyzed to provide a disease-specific estimate of SARS-CoV-2 infection outcomes in pediatric ALL. Of 253 patients with reported infections, the majority (77.1%) were asymptomatic or mildly symptomatic (CTCAE grade 1/2) and there was a single COVID-19-related death. These data suggest SARS-CoV-2 infection does not confer substantial morbidity among young patients with B-lymphoblastic leukemia/lymphoma (B-ALL/LLy).
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Affiliation(s)
- Caitlin W. Elgarten
- Department of PediatricsDivision of OncologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - John A. Kairalla
- Department of BiostatisticsUniversity of FloridaGainesvilleFloridaUSA
| | - Joel C. Thompson
- Department of PediatricsDivision of Hematology/Oncology/Bone Marrow TransplantChildren's Mercy HospitalUniversity of Missouri ‐ Kansas CityKansas CityMissouriUSA
| | - Tamara P. Miller
- Pediatric Hematology/OncologyChildren's Healthcare of Atlanta ‐ EglestonAtlantaGeorgiaUSA
| | - Cindy Wang
- Department of BiostatisticsUniversity of FloridaGainesvilleFloridaUSA
| | - Susan Conway
- Department of BiostatisticsUniversity of FloridaGainesvilleFloridaUSA
| | - Mignon L. Loh
- Ben Towne Center for Childhood Cancer ResearchSeattle Children's Research Institute and Department of PediatricsSeattle Children's HospitalUniversity of WashingtonSeattleWashingtonUSA
| | - Elizabeth A. Raetz
- Laura and Isaac Perlmutter Cancer Center at NYU LangoneNew YorkNew YorkUSA
| | - Sumit Gupta
- Division of Hematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
| | - Rachel E. Rau
- Pediatric Hematology/OncologyBaylor College of MedicineHoustonTexasUSA
| | - Anne Angiolillo
- Center for Cancer and Blood DisordersChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Karen R. Rabin
- Pediatric Hematology/OncologyBaylor College of MedicineHoustonTexasUSA
| | - Sarah Alexander
- Division of Hematology/OncologyHospital for Sick ChildrenTorontoOntarioCanada
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10
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Martin SD, Davis ES, Dai C, Boal LH, Araya B, Brackett J, Dickens D, Kahn A, Martinez I, Sharma A, Schwalm C, Aguayo-Hiraldo P, Bhatia S, Levine JM, Johnston EE, Wolfson JA. Clinical Features and Risk Factors Associated With Multisystem Inflammatory Syndrome in Children With Cancer and COVID-19. JAMA Oncol 2023; 9:1108-1112. [PMID: 37166782 PMCID: PMC10176181 DOI: 10.1001/jamaoncol.2023.0525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/27/2023] [Indexed: 05/12/2023]
Abstract
Importance Little is known about the risk of post-COVID-19 multisystem inflammatory syndrome in children (MIS-C) in the setting of childhood cancer. Objective To evaluate factors associated with MIS-C and describe the clinical course of COVID-19 in the setting of MIS-C. Design, Setting, and Participants Multisite observational cohort study of a registry representing more than 100 US pediatric oncology sites. All included patients were registered between April 1, 2020, and May 18, 2022. Sites submitted deidentified data surrounding sociodemographics, cancer diagnosis and treatment, and COVID-19 course (symptoms, maximum support required, outcome). Patients with MIS-C (n = 24) were compared with matched controls (n = 96). Children (<21 years) with cancer who developed COVID-19 while receiving cancer treatment or within 1 year of completing treatment were characterized based on their development of MIS-C. Exposures (1) Clinical and sociodemographic characteristics of children with cancer and COVID-19; and (2) MIS-C. Main Outcomes and Measures (1) Development of MIS-C among children with cancer and COVID-19; and (2) symptoms and disease severity associated with MIS-C. Results Among 2035 children with cancer and COVID-19, 24 (1.2%) developed MIS-C. COVID-19 occurred at a median (IQR) age of 12.5 (5.5-17.1) years in those with MIS-C and 11 (6-16) years among matched controls (P = .86). The majority of children with MIS-C had a hematologic cancer (83.3% [n = 20]), were publicly insured (66.7% [n = 16]), and were Hispanic (54.2% [n = 13]). Half (n = 12) had 1 or more noncancer comorbidity. Those with comorbidities were more likely to develop MIS-C than those without (odds ratio [OR], 2.5 [95% CI, 1.1-5.7]). Among children with MIS-C, 100% (n = 24) were admitted to the hospital and 54.2% (n = 13) to the intensive care unit (ICU), while COVID-19 contributed to the death of 20.1% (n = 5); cancer therapy was changed in 62.5% (n = 15). Compared with matched controls, those with MIS-C had higher odds of symptoms classified as systemic (OR, 4.7 [95% CI, 1.4-15.8]) or gastrointestinal (OR, 5.0 [95% CI, 1.7-14.6]) along with higher odds of hospitalization (OR, 42.9 [95% CI, 7.1-258]), ICU admission (OR, 11.4 [95% CI, 3.6-36.4]), and changes to cancer therapy (OR, 24.9 [95% CI, 6.5-94.8]). Conclusions and Relevance In this cohort study among children with cancer and COVID-19, those with MIS-C had a more severe clinical course than those without MIS-C. The risk of MIS-C and its severity are important to consider as clinicians monitor patients with COVID-19. These findings can inform their conversations with families regarding COVID-19 risks and the benefits of prevention strategies that are pharmacologic (vaccination) and nonpharmacologic (masking), as well as treatment (antivirals, monoclonal antibodies).
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Affiliation(s)
| | - Elizabeth S. Davis
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Lauren H. Boal
- Department of Pediatrics, Massachusetts General Hospital, Boston
| | - Brook Araya
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children’s Hospital, Houston
| | - David Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City
| | - Alissa Kahn
- Pediatric Hematology-Oncology, Department of Pediatrics, Saint Joseph’s University Medical Center, Paterson, New Jersey
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, Kalamazoo, Michigan
| | - Paibel Aguayo-Hiraldo
- Division of Hematology-Oncology, Department of Pediatrics, Children’s Hospital of Los Angeles, Los Angeles, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham
| | - Jennifer M. Levine
- Pediatric Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, New York
| | - Emily E. Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham
| | - Julie A. Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham
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11
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Nigro O, Oltolini C, Barzaghi F, Uberti Foppa C, Cicalese MP, Massimino M, Schiavello E. Pediatric cancer care management during the COVID-19 pandemic: a review of the literature and a single-centre real-life experience of an Italian pediatric oncology unit. Expert Rev Anticancer Ther 2023; 23:927-942. [PMID: 37712347 DOI: 10.1080/14737140.2023.2245148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The severe acute respiratory syndrome coronavirus-2 pandemic significantly affected clinical practice, also in pediatric oncology units. Cancer patients needed to be treated with an adequate dose density despite the SARS-CoV-2 infection, balancing risks of developing severe COVID-19 disease. AREAS COVERED Although the pandemic spread worldwide, the prevalence of affected children was low. The percentage of children with severe illness was approximately 1-6%. Pediatric cancer patients represent a prototype of a previously healthy immune system that is hampered by the tumor itself and treatments, such as chemotherapy and steroids. Through a review of the literature, we reported the immunological basis of the response to SARS-CoV-2 infection, the existing antiviral treatments used in pediatric cancer patients, and the importance of vaccination. In conclusion, we reported the real-life experience of our pediatric oncology unit during the pandemic period. EXPERT OPINION Starting from the data available in literature, and our experience, showing the rarity of severe COVID-19 disease in pediatric patients with solid tumors, we recommend carefully tailoring all the oncological treatments (chemotherapy/targeted therapy/stem cell transplantation/radiotherapy). The aim is the preservation of the treatment's timing, balanced with an evaluation of possible severe COVID-19 disease.
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Affiliation(s)
- Olga Nigro
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Uberti Foppa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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12
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Johnston EE, Meng Q, Hageman L, Wu J, Ross E, Lim S, Balas N, Bosworth A, Te HS, Francisco L, Bhatia R, Forman SJ, Wong FL, Armenian SH, Weisdorf DJ, Landier W, Bhatia S. Risk of COVID-19 infection in long-term survivors of blood or marrow transplantation: a BMTSS report. Blood Adv 2023; 7:2843-2854. [PMID: 36724527 PMCID: PMC9906674 DOI: 10.1182/bloodadvances.2022009550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
There is limited information regarding COVID-19 in long-term blood or marrow transplant (BMT) survivors. We leveraged the BMT Survivor Study (BMTSS) to address this gap. BMTSS included patients who underwent BMT at 1 of 3 sites in the United States between 1974 and 2014 and survived ≥2 years after BMT. A sibling cohort serves as a non-BMT comparison group. Participants (2430 BMT survivors; 780 non-BMT participants) completed the BMTSS survey between October 2020 and November 2021 about COVID-19 testing, risk mitigation behaviors, morbidity, and health care use. Median age at BMT was 46 years (range, 0-78 years) and median follow-up since BMT was 14 years (6-46 years); 76% were non-Hispanic White, 54% had received allogeneic BMT. The risk of COVID-19 infection was comparable for BMT survivors vs non-BMT participants (15-month cumulative incidence, 6.5% vs 8.1%; adjusted odd ratio [aOR] = 0.93; 95% confidence interval [CI], 0.65-1.33; P = .68). Among survivors, being unemployed (aOR 1.90; 95% CI, 1.12-3.23; P = .02; reference: retired) increased the odds of infection; always wearing a mask in public was protective (aOR = 0.49; 95% CI, 0.31-0.77; P = .002; reference: not always masking). When compared with COVID-positive non-BMT participants, COVID-positive BMT survivors had higher odds of hospitalization (aOR = 2.23; 95% CI, 0.99-5.05; P = .05); however, the odds of emergency department visits were comparable (aOR = 1.60; 95% CI = 0.71-3.58; P = .25). COVID-19 infection status did not increase the odds of hospitalization among BMT survivors (aOR = 1.32; 95% CI = 0.89-1.95; P = .17) but did increase the odds of emergency department visits (aOR = 2.63; 95% CI, 1.74-3.98; P <.0001). These findings inform health care providers about the management of care for long-term BMT survivors during the ongoing pandemic.
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Affiliation(s)
- Emily E. Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Qingrui Meng
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Wu
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth Ross
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Shawn Lim
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Nora Balas
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | | | - Hok Sreng Te
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Ravi Bhatia
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen J. Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - F. Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA
| | | | - Daniel J. Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
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13
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McNerney KO, Richards RM, Aguayo-Hiraldo P, Calkoen FG, Talano JA, Moskop A, Balduzzi A, Krajewski J, Dave H, Vatsayan A, Callahan C, Liu H, Li Y, Davis KL, Maude SL. SARS-CoV-2 infections in pediatric and young adult recipients of chimeric antigen receptor T-cell therapy: an international registry report. J Immunother Cancer 2023; 11:jitc-2022-005957. [PMID: 36707090 PMCID: PMC9884906 DOI: 10.1136/jitc-2022-005957] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Immunocompromised patients are at increased risk of SARS-CoV-2 infections. Patients undergoing chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory B-cell malignancies are uniquely immunosuppressed due to CAR T-mediated B-cell aplasia (BCA). While SARS-CoV-2 mortality rates of 33%-40% are reported in adult CAR T-cell recipients, outcomes in pediatric and young adult CAR T-cell recipients are limited. METHODS We created an international retrospective registry of CAR T recipients aged 0-30 years infected with SARS-CoV-2 within 2 months prior to or any time after CAR T infusion. SARS-CoV-2-associated illness was graded as asymptomatic, mild, moderate, or severe COVID-19, or multisystem inflammatory syndrome in children (MIS-C). To assess for risk factors associated with significant SARS-CoV-2 infections (infections requiring hospital admission for respiratory distress or supplemental oxygen), univariate and multivariable regression analyses were performed. RESULTS Nine centers contributed 78 infections in 75 patients. Of 70 SARS-CoV-2 infections occurring after CAR T infusion, 13 (18.6%) were classified as asymptomatic, 37 (52.9%) mild, 11 (15.7%) moderate, and 6 (8.6%) severe COVID-19. Three (4.3%) were classified as MIS-C. BCA was not significantly associated with infection severity. Prior to the emergence of the Omicron variant, of 47 infections, 19 (40.4%) resulted in hospital admission and 7 (14.9%) required intensive care, while after the emergence of the Omicron variant, of 23 infections, only 1 (4.3%) required admission and the remaining 22 (95.7%) had asymptomatic or mild COVID-19. Death occurred in 3 of 70 (4.3%); each death involved coinfection or life-threatening condition. In a multivariable model, factors associated with significant SARS-CoV-2 infection included having two or more comorbidities (OR 7.73, CI 1.05 to 74.8, p=0.048) and age ≥18 years (OR 9.51, CI 1.90 to 82.2, p=0.014). In the eight patients infected with SARS-CoV-2 before CAR T, half of these patients had their CAR T infusion delayed by 15-30 days. CONCLUSIONS In a large international cohort of pediatric and young adult CAR-T recipients, SARS-CoV-2 infections resulted in frequent hospital and intensive care unit admissions and were associated with mortality in 4.3%. Patients with two or more comorbidities or aged ≥18 years were more likely to experience significant illness. Suspected Omicron infections were associated with milder disease.
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Affiliation(s)
- Kevin Owen McNerney
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA,Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca M Richards
- Hematology, Oncology, and Bone Marrow Transplant, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paibel Aguayo-Hiraldo
- Cancer and Blood Disease Institute, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Friso G Calkoen
- Division of Pediatric Oncology, Princess Maxima Center, Utrecht, The Netherlands
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow TransplantationDepartment of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy Moskop
- Division of Hematology/Oncology/Blood and Marrow TransplantationDepartment of Pediatrics, Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, Wisconsin, USA
| | - Adriana Balduzzi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione IRCCS San Gerardo dai Tintori, Milan, Italy
| | - Jennifer Krajewski
- Pediatric Blood and Marrow Transplantation, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | - Hema Dave
- Cancer Immunology and Microbial Oncology Research Program, Children's National Hospital, Washington, District of Columbia, USA
| | - Anant Vatsayan
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Colleen Callahan
- Division of Oncology and Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hongyan Liu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kara Lynn Davis
- Pediatrics, Stanford University School of Medicine, Stanford, California, USA,Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford, California, USA
| | - Shannon L Maude
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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14
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Rykov MY, Dolgopolov IS. COVID-19 coronavirus infection in children: Clinical presentation, diagnosis, vaccination, and treatment. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2022-67-6-14-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In late 2019, a new subtype of coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19 SARS-CoV-2) rapidly spread around the world, causing a global pandemic. Initially, the proportion of confirmed cases among children was relatively small, and it was believed that children were rarely infected. Subsequent observations have shown that in children and adolescents, the infection is either asymptomatic or paucisymptomatic, and therefore the true incidence is underestimated due to the lack of testing. The article systematizes the results of studies on the prevalence, diagnosis, clinical features, vaccination, and treatment of children with a new coronavirus infection COVID-19 SARS-CoV-2. The SARS-CoV-2 positivity rate throughout the peak of the pandemic in children was low compared to adults. Children are not only less likely to become infected with the virus, but they also endure the infection more easily than adults. The mortality rate in children with COVID-19 was <0.5%. In most children, infection is either asymptomatic or paucisymptomatic. Vaccination of children and adolescents is recommended mainly to achieve herd immunity in all age groups. However, there are no convincing data on the duration of the immune response, the level of the required protective antibody titer, as well as on the long-term side effects of vaccination due to the insufficient follow-up period and the uncertainty of the immune response criteria. As information is accumulated on the viral load of children and adolescents, their role in the transmission of the virus, diagnostic approaches in this age group are optimized. The effectiveness of the treatment was tested on patients admitted to the hospital, and recommendations for treatment were developed. Currently, global research efforts are focused on the protection of particularly vulnerable children, the prospects for total childhood vaccination, its effectiveness and safety.
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Affiliation(s)
- M. Yu. Rykov
- Russian State Social University; Semashko National Research Institute of Public Health
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15
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Sundberg E, Georgantzi K, Langenskiöld C, Król L, Nilsson F, Vogt H, Palle J, Ek T, Nilsson A. Low numbers of COVID-19 in Swedish pediatric oncology patients during the first pandemic year despite an open society. Pediatr Blood Cancer 2022; 69:e29750. [PMID: 35484955 PMCID: PMC9088657 DOI: 10.1002/pbc.29750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/07/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sweden adopted a different strategy than many other countries to combat the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and kept most schools open. Initial reports from China suggested that coronavirus disease 2019 (COVID-19) was milder in children compared to adults, but there was a lack of data from immunocompromised children. Therefore, we investigated the rate of verified SARS-CoV-2 infections in our Swedish pediatric oncology patients. PROCEDURE This was a multicenter retrospective study. A questionnaire including patient data as well as SARS-CoV-2 data was sent to the six Swedish childhood cancer centers in May 2021. RESULTS During the first pandemic year, 49 patients were identified as SARS-CoV-2 positive, and 22 (45%) children were hospitalized with COVID-19. Two children needed intensive care, but no COVID-19-related deaths were reported. Most patients (n = 36, 73%) were on active chemotherapy treatment and 23 children (49%) attended school or daycare at least part-time. Half of the SARS-CoV-2-positive patients experienced a delay in cancer treatment. CONCLUSIONS Despite the rapid spread of SARS-CoV-2 in Sweden, without a strict lockdown of the society, the number of nationally reported pediatric oncology patients with polymerase chain reaction (PCR)-verified infection was low, and the majority of children had mild disease. Our data show that treatment interruptions occurred frequently and this should clearly be avoided for the coming years.
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Affiliation(s)
- Emil Sundberg
- Department of Children's Oncology and HematologyUppsala University HospitalUppsalaSweden,Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Kleopatra Georgantzi
- Division of Pediatric Hematology‐OncologyTema Barn, Astrid Lindgren Children's HospitalStockholmSweden
| | | | - Ladislav Król
- Division of Pediatric Hematology‐OncologySkåne University HospitalLundSweden
| | - Frans Nilsson
- Division of Pediatric Hematology‐OncologyUmeå University HospitalUmeåSweden
| | - Hartmut Vogt
- Crown Princess Victoria's Child and Youth Hospital, Division of Pediatric Hematology‐Oncology B153, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Josefine Palle
- Department of Children's Oncology and HematologyUppsala University HospitalUppsalaSweden
| | - Torben Ek
- Children's Cancer CentreQueen Silvia Children's HospitalGothenburgSweden
| | - Anna Nilsson
- Division of Pediatric Hematology‐OncologyTema Barn, Astrid Lindgren Children's HospitalStockholmSweden,Department of Women's and Children's HealthKarolinska InstitutetSolnaSweden
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16
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Caniza MA, Homsi MR, Bate J, Adrizain R, Ahmed T, Alexander S, Bhattacharyya A, Copado‐Gutierrez JL, Gutierrez I, Lim YY, Morrissey L, Naidu G, Paintsil V, Radhakrishnan N, Mukkada S, Phillips R, Alexander KA, Pritchard‐Jones K. Answers to common questions about COVID-19 vaccines in children with cancer. Pediatr Blood Cancer 2022; 69:e29985. [PMID: 36114651 PMCID: PMC9538403 DOI: 10.1002/pbc.29985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The SARS-CoV-2 outbreak in 2020 evolved into a global pandemic, and COVID-19 vaccines became rapidly available, including for pediatric patients. However, questions emerged that challenged vaccine acceptance and use. We aimed to answer these questions and give recommendations applicable for use in pediatric patients with cancer by healthcare professionals and the public. METHODS A 12-member global COVID-19 Vaccine in Pediatric Oncology Working Group made up of physicians and nurses from all world regions met weekly from March to July 2021. We used a modified Delphi method to select the top questions. The Working Group, in four-member subgroups, answered assigned questions by providing brief recommendations, followed by a discussion of the rationale for each answer. All Working Group members voted on each recommendation using a scale of 1 to 10, 10 being complete agreement. A "pass" recommendation corresponded to an agreement ≥7.5. RESULTS We selected 15 questions from 173 suggested questions. Based on existing published information, we generated answers for each question as recommendations. The overall average agreement for the 24 recommendations was 9.5 (95% CI 9.4-9.6). CONCLUSION Top COVID-19 vaccine-related questions could be answered using available information. Reports on COVID-19 vaccination and related topics have been published at record speed, aided by available technology and the priority imposed by the pandemic; however, all efforts were made to incorporate emerging information throughout our project. Recommendations will be periodically updated on a dedicated website.
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Affiliation(s)
- Miguela A. Caniza
- Departments of Global Pediatric Medicine, St. Jude Children's Research HospitalMemphisTennesseeUSA,Departments of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennesseeUSA,Department of or PediatricsUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Maysam R. Homsi
- Departments of Global Pediatric Medicine, St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jessica Bate
- Department of Paediatric OncologySouthampton Children's HospitalSouthamptonUK
| | - Riyadi Adrizain
- Department of Child HealthFaculty of Medicine Universitas Padjadjaran Dr. Hasan Sadikin General HospitalBandungIndonesia
| | - Tarek Ahmed
- Department of Pediatric OncologyChildren's Cancer Hospital EgyptCairoEgypt
| | - Sarah Alexander
- Division of Haematology/Oncology, Hospital for Sick Children, Department of PediatricsUniversity of TorontoTorontoCanada
| | | | | | - Ivan Gutierrez
- Department of Pediatric Infectious DiseasesResearch Group Colsubsidio InvestigaClinical Infantil ColsubsidioBogotáColombia,Division of Pediatric Infectious DiseasesClinica Infantil Santa María del LagoBogotáColombia
| | - Yan Yin Lim
- Division of NursingKK Women's and Children's HospitalSingaporeSingapore
| | - Lisa Morrissey
- Department of NursingBoston Children's HospitalBostonMassachusettsUSA
| | - Gita Naidu
- Department of Pediatric OncologyChris Hani Baragwanath Academic HospitalUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Vivian Paintsil
- Department of Child HealthSchool of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Nita Radhakrishnan
- Department of Pediatric Hematology OncologyPost Graduate Institute of Child HealthNoidaIndia
| | - Sheena Mukkada
- Departments of Global Pediatric Medicine, St. Jude Children's Research HospitalMemphisTennesseeUSA,Departments of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Robert Phillips
- Regional Department of Hematology and OncologyLeeds Children's HospitalLeedsUK,Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - Kenneth A. Alexander
- Department of PediatricsDivision of Infectious DiseasesNemours Children's Hospital‐FloridaOrlandoFloridaUSA
| | - Kathy Pritchard‐Jones
- Developmental Biology and Cancer Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
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17
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Madney Y, Shalaby L, Hammad M, Elanany M, Hassan R, Youssef A, Abdo I, Zaki A, Khedr R. COVID-19-Associated Pulmonary Fungal Infection among Pediatric Cancer Patients, a Single Center Experience. J Fungi (Basel) 2022; 8:jof8080850. [PMID: 36012838 PMCID: PMC9409978 DOI: 10.3390/jof8080850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with COVID-19 are at risk of developing secondary complications such as invasive pulmonary aspergillosis and mucormycosis. This is a retrospective study including all cancer children diagnosed with COVID-19-associated pulmonary fungal infection (CAPFI) during the period 2020–2021. A total of 200 patients were diagnosed with COVID-19, out of which 21 (10%) patients were diagnosed with CAPFI, 19 patients (90%) with COVID-aspergillosis (CAPA), and 2 (10%) patients with COVID-mucormycosis (CAM). Patients with CAPFI were classified using the “2020 ECMM/ISHAM consensus criteria”; proven in 2 (10%) patients, probable in 12 (57%), and possible in 7 (33%) patients. Although the hematological malignancy patients were already on antifungal prophylaxis, breakthrough fungal infection was reported in 16/21 (75%), 14 (65%) patients had CAPA while on echinocandin prophylaxis, while 2 (10%) patients had CAM while on voriconazole prophylaxis. Overall mortality was reported in 8 patients (38%) while CAPFI-attributable mortality was reported in 4 patients (20%). In conclusion, clinicians caring for pediatric cancer patients with COVID-19 should consider invasive pulmonary fungal infection, even if they are on antifungal prophylaxis, especially with worsening of the clinical chest condition. A better understanding of risk factors for adverse outcomes may improve clinical management in these patients.
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Affiliation(s)
- Youssef Madney
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
- Correspondence:
| | - Lobna Shalaby
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Mahmoud Hammad
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Mervat Elanany
- Clinical Pathology Department, Faculty of Medicine, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Reem Hassan
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Ayda Youssef
- Radiodiagnosis Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Ibrahim Abdo
- Clinical Pharmacology Department, Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Abeer Zaki
- Clinical Research Department, Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Reham Khedr
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
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18
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Abu Shanap M, Sughayer M, Alsmadi O, Elzayat I, Al-Nuirat A, Tbakhi A, Sultan I. Factors that predict severity of infection and seroconversion in immunocompromised children and adolescents with COVID-19 infection. Front Immunol 2022; 13:919762. [PMID: 35990639 PMCID: PMC9381983 DOI: 10.3389/fimmu.2022.919762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWe aimed to study the outcomes, severity, and seroconversion post SARS-CoV-2 infection in immunocompromised children and adolescents treated at our center.MethodFor this observational study, all pediatric patients who had COVID-19 infection from Sep-22-2020 to Nov-10-2021were identified by reviewing our laboratory records. Their charts were reviewed to determine clinical severity and outcome. Blood samples were drawn for anti-SARS-CoV-2 antibody assay. Serious COVID-19 infection (SVI) was defined if the patient had moderate, severe, or critical illness. A cutoff of 100 U/mL anti-SARS-CoV-2 antibodies was used to categorize low and high titer seroconversion.ResultsWe identified 263 pediatric patients with COVID-19; most (68%) were symptomatic: 5% had severe or critical infection, 25% were hospitalized, 12 required respiratory support, 12 were admitted to the ICU, and five patients (2%) died. Multivariable analysis revealed several factors that predict SVI: Age above 12 years (p=0.035), body mass index above 95th percentile (p=0.034), comorbid conditions (p=0.025), absolute neutrophil count ≤500(p=0.014) and absolute lymphocyte count ≤300 (p=0.022). Levels of anti-SARS-CoV-2 spike antibodies were obtained for 173 patients at a median of 94 days (range, 14–300) after PCR diagnosis; of them 142 (82%) patients seroconverted; the lowest seroconversion rate was observed in patients with hematological malignancies (79%). Our univariable model showed that the following factors were predictive of low titer: lower ANC, p=0.01; hematologic malignancy, p=0.023; receiving steroids in the last 14 days, p=0.032; time since last chemotherapy or immunosuppressive therapy less than 30 days, p=0.002; and being on active chemotherapy in the last 3 months prior to infection, p<0.001.ConclusionsSARS-CoV-2 antibodies developed in most immunocompromised patients with COVID-19 infection in our study. Mortality was relatively low in our patients. Our univariable and multivariable models showed multiple variables that predict severity of infections and antibody response post COVID-19 infection. These observations may guide choice of active therapy during infection and the best timing of vaccination in this high-risk population.
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Affiliation(s)
- Mayada Abu Shanap
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
- *Correspondence: Mayada Abu Shanap,
| | - Maher Sughayer
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Osama Alsmadi
- Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman, Jordan
| | - Ismail Elzayat
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Abeer Al-Nuirat
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Abdelghani Tbakhi
- Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman, Jordan
| | - Iyad Sultan
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
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19
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Parker RS, Le J, Doan A, Aguayo-Hiraldo P, Pannaraj PS, Rushing T, Malvar J, O'Gorman MR, Dien Bard J, Parekh C. COVID-19 outcomes in children, adolescents and young adults with cancer. Int J Cancer 2022; 151:1913-1924. [PMID: 35793239 PMCID: PMC9350252 DOI: 10.1002/ijc.34202] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/16/2022] [Accepted: 06/21/2022] [Indexed: 11/08/2022]
Abstract
Pediatric oncology patients are at risk for poor outcomes with respiratory viral infections. Outcome data for COVID‐19 in children and young adults with cancer are needed; data are sparse for obese/overweight and adolescent and young adult subgroups. We conducted a single center cohort study of COVID‐19 outcomes in patients younger than 25 years with cancer. Candidate hospitalization risk factors were analyzed via univariable and multivariable analyses. Eighty‐seven patients with cancer and COVID‐19 were identified. Most were Hispanic/Latinx (n = 63, 72%). Forty‐two (48%) were overweight/obese. Anticancer therapy included chemotherapy only (n = 64, 74%), chimeric antigen receptor T‐cells (CAR‐T, n = 7), hematopoietic stem cell transplantation (HSCT, n = 12), or CAR‐T and HSCT (n = 4). There was no COVID‐19 related mortality. Twenty‐six patients (30%) required COVID‐19 related hospitalization; 4 required multiple hospitalizations. Nine (10%) had severe/critical infection; 6 needed intensive care. COVID‐19 resulted in anticancer therapy delays in 22 (34%) of 64 patients on active therapy (median delay = 14 days). Factors associated with hospitalization included steroids within 2 weeks prior to infection, lymphopenia, previous significant non‐COVID infection, and low COVID‐19 PCR cycle threshold value. CAR‐T recipients with B‐cell aplasia tended to have severe/critical infection (3 of 7 patients). A COVID‐19 antibody response was detected in 14 of 32 patients (44%). A substantial proportion of COVID‐19 infected children and young adults with cancer require inpatient management; morbidity may be high in B‐cell immunodeficiency. However, a majority of patients can be taken through chemotherapy without prolonged therapy delays. Viral load is a potential outcome predictor in COVID‐19 in pediatric cancer.
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Affiliation(s)
- Rebecca S Parker
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Justin Le
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Andrew Doan
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Paibel Aguayo-Hiraldo
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Pia S Pannaraj
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Teresa Rushing
- Department of Pharmacy, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jemily Malvar
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Maurice R O'Gorman
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Department of Pathology and Laboratory Medicine, Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Chintan Parekh
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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20
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Majeed A, Wright T, Guo B, Arora RS, Lam CG, Martiniuk AL. The Global Impact of COVID-19 on Childhood Cancer Outcomes and Care Delivery - A Systematic Review. Front Oncol 2022; 12:869752. [PMID: 35463381 PMCID: PMC9023072 DOI: 10.3389/fonc.2022.869752] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Childhood cancer represents a leading cause of death and disease burden in high income countries (HICs) and low-and-middle income countries (LMICs). It is postulated that the current COVID-19 pandemic has hampered global development of pediatric oncology care programs. This systematic review aimed to comprehensively review the global impact of COVID-19 on childhood cancer clinical outcomes and care delivery. Methods A systematic search was conducted on PubMed, Embase, Medline, and the African Medical Index from inception to November 3, 2021 following PRISMA guidelines. A manual search was performed to identify additional relevant studies. Articles were selected based on predetermined eligibility criteria. Findings The majority of studies reported patients with cancer and COVID-19 presenting as asymptomatic (HICs: 33.7%, LMICs: 22.0%) or with primary manifestations of fever (HICs: 36.1%, LMICs: 51.4%) and respiratory symptoms (HICs: 29.6%, LMICs: 11.7%). LMICs also reported a high frequency of patients presenting with cough (23.6%) and gastrointestinal symptoms (10.6%). The majority of patients were generally noted to have a good prognosis; however the crude mortality rate was higher in LMICs when compared to HICs (8.0% vs 1.8%). Moreover, the pandemic has resulted in delays and interruptions to cancer therapies and delays in childhood cancer diagnoses in both HICs and LMICs. However, these findings were disproportionately reported in LMICs, with significant staff shortages, supply chain disruptions, and limited access to cancer therapies for patients. Conclusions The COVID-19 pandemic has resulted in delays and interruptions to childhood cancer therapies and delays in childhood cancer diagnoses, and disproportionately so within LMICs. This review provides lessons learned for future system-wide disruptions to care, as well as provides key points for moving forward better with care through the remainder of this pandemic. Systematic Review Registration CRD42021266758, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=266758
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Affiliation(s)
- Amna Majeed
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tom Wright
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Biqi Guo
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Catherine G Lam
- Department of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Alexandra L Martiniuk
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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21
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Gupta S, Sutradhar R, Alexander S, Science M, Lau C, Nagamuthu C, Agha M, Nathan PC, Hodgson D. Risk of COVID-19 Infections and of Severe Complications Among Survivors of Childhood, Adolescent, and Young Adult Cancer: A Population-Based Study in Ontario, Canada. J Clin Oncol 2022; 40:1281-1290. [PMID: 35226549 DOI: 10.1200/jco.21.02592] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Survivors of childhood, adolescent, and young adult cancer are at risk of late effects, including pulmonary and infectious complications. Whether survivors are at increased risk of COVID-19 infection and severe complications is unknown. METHODS Population-based registries in Ontario, Canada, identified all 5-year survivors of childhood cancer diagnosed age 0-17 years between 1985 and 2014, and of six common adolescent and young adult cancers diagnosed age 15-21 years between 1992 and 2012. Each survivor alive on January 1, 2020, was randomly matched by birth year, sex, and residence to 10 cancer-free population controls. Individuals were linked to population-based laboratory and health care databases to identify COVID-19 tests, vaccinations, infections, and severe outcomes (emergency department [ED] visits, hospitalizations, intensive care unit admissions, and death within 60 days). Demographic, disease, and treatment-related variables were examined as possible predictors of outcomes. RESULTS Twelve thousand four hundred ten survivors were matched to 124,100 controls. Survivors were not at increased risk of receiving a positive COVID-19 test (386 [3.1%] v 3,946 [3.2%]; P = .68) and were more likely to be fully vaccinated (hazard ratio, 1.23; 95 CI, 1.20 to 1.37). No increase in risk among survivors was seen in emergency department visits (adjusted odds ratio, 1.2; 95 CI, 0.9 to 1.6; P = .19) or hospitalization (adjusted odds ratio, 1.8; 95 CI, 1.0 to 3.5; P = .07). No survivor experienced intensive care unit admission or died after COVID-19 infection. Pulmonary radiation or chemotherapies associated with pulmonary toxicity were not associated with increased risk. CONCLUSION Cancer survivors were not at increased risk of COVID-19 infections or severe sequelae. These results can inform risk-counseling of survivors and their caregivers. Further study is warranted to determine risk in older survivors, specific subsets of survivors, and that associated with novel COVID-19 variants.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michelle Science
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Cindy Lau
- Cancer Research Program, ICES, Toronto, Canada
| | | | - Mohammad Agha
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Pediatric Oncology Group of Ontario, Toronto, Canada.,Primary Care & Health Systems Research Program, ICES, Toronto, Canada
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada
| | - David Hodgson
- Pediatric Oncology Group of Ontario, Toronto, Canada.,Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
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22
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Ilinca AP, Dakhallah N, Souza AM, Liu J, Bérubé S, Brossard J, Vézina C, Pelland-Marcotte MC, Santiago R, Tran TH. Clinical characteristics and outcomes of SARS-CoV-2 infection in pediatric oncology patients in the province of Quebec. Pediatr Blood Cancer 2022; 69:e29572. [PMID: 35084108 DOI: 10.1002/pbc.29572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/09/2023]
Affiliation(s)
- André P Ilinca
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Nawar Dakhallah
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Amalia M Souza
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Jessica Liu
- Division of Pediatric Hematology-Oncology, CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Samuel Bérubé
- Division of Pediatric Hematology-Oncology, CHUL, Université Laval, Quebec City, Québec, Canada
| | - Josée Brossard
- Division of Pediatric Hematology-Oncology, CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Catherine Vézina
- Division of Pediatric Hematology-Oncology, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | | | - Raoul Santiago
- Division of Pediatric Hematology-Oncology, CHUL, Université Laval, Quebec City, Québec, Canada
| | - Thai Hoa Tran
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
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23
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Sharafeldin N, Bates B, Vachhani P. How the COVID-19 Pandemic Reshaped the Management of Leukemia and Affected Patient Outcomes. Curr Treat Options Oncol 2022; 23:688-702. [PMID: 35334062 PMCID: PMC8951659 DOI: 10.1007/s11864-022-00975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
The coronavirus disease-19 (COVID-19) pandemic has posed numerous challenges to the global healthcare system. Of particular gravity is adult and pediatric patients with hematologic malignancies who are among the most vulnerable groups of patients at risk of severe COVID-19 outcomes. In the early phases of the pandemic, several treatment modifications were proposed for patients with leukemia. Largely speaking, these were adopting less-intense therapies and more utilization of the outpatient setting. Over time, our understanding and management have become more nuanced. Furthermore, equipped with vaccinations to prevent COVID-19 infection and availability of treatments in the presence of COVID-19 infection, the recommendations on management of patients with leukemia have evolved. Patient’s leukemia characteristics, possibility of targeted therapy, vaccination status, symptomatology, comorbidities, goal of anti-leukemic therapy, the intensity of therapy, the setting of treatment, as well as loco regional factors like dynamic incidence of COVID-19 in the community and hospital/ICU bed status are among many factors that influence the decisions. Furthermore, the oncology community has adopted delaying the anti-leukemia therapy for a limited time frame, if clinically possible, so as to still deliver most appropriate therapy while minimizing risks. Early adoption of growth factor support and conservative blood transfusion practices have helped as well. In this review, we discuss the impact of COVID-19 on outcomes and share considerations for treatments of leukemias. We describe the impact on both clinical care (from diagnosis to treatment) and research, and cover the literature on vaccines and treatments for COVID-19 in relation to leukemia.
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Affiliation(s)
- Noha Sharafeldin
- Division of Hematology and Oncology and O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA.
| | - Benjamin Bates
- The Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Pankit Vachhani
- Division of Hematology and Oncology and O'Neal Comprehensive Cancer Center, Heersink School of Medicine, University of Alabama at Birmingham (UAB), 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA
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24
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Villeneuve S, Aftandilian C. Neutropenia and Infection Prophylaxis in Childhood Cancer. Curr Oncol Rep 2022; 24:671-686. [PMID: 35230594 PMCID: PMC8885776 DOI: 10.1007/s11912-022-01192-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Pediatric oncology patients frequently experience episodes of prolonged neutropenia which puts them at high risk for infection with significant morbidity and mortality. Here, we review the data on infection prophylaxis with a focus on both pharmacologic and ancillary interventions. This review does not include patients receiving hematopoietic stem cell transplantation. RECENT FINDINGS Patients with hematologic malignancies are at highest risk for infection. Bacterial and fungal prophylaxis decrease the risk of infection in certain high-risk groups. Ancillary measures such as ethanol locks, chlorhexidine gluconate baths, GCSF, IVIG, and mandatory hospitalization do not have enough data to support routine use. There is limited data on risk of infection and role of prophylaxis in patients receiving immunotherapy and patients with solid tumors. Patients with Down syndrome and adolescent and young adult patients may benefit from additional supportive care measures and protocol modifications. Consider utilizing bacterial and fungal prophylaxis in patients with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. More research is needed to evaluate other supportive care measures and the role of prophylaxis in patients receiving immunotherapy.
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Affiliation(s)
- Stephanie Villeneuve
- Paediatric Haemotology/Oncology, Dalhousie University and the IWK Health Centre, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Catherine Aftandilian
- Pediatric Hematology/Oncology, Stanford University, 1000 Welch Rd, Palo Alto, CA, 94304, USA.
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25
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Wolfson JA, Dye CC, Levine JM. How can we create resilient research systems in a pandemic? Cancer 2021; 128:651-653. [PMID: 34767641 DOI: 10.1002/cncr.34002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Julie A Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Candice C Dye
- Division of Academic General Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer M Levine
- Division of Pediatric Hematology-Oncology, Weill Cornell Medicine, New York, New York
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