Childhood cancers

Children and adolescents with cancer are at high-risk of developing severe COVID-19 illness

Children and adolescents with cancer are at high-risk of developing severe COVID-19 illness, data from an international registry show.

The Global Registry of COVID-19 in Childhood Cancer has confirmed that laboratory-confirmed SARS-CoV-2 infection is reported mostly in paediatric cancer patients with a haematological malignancy.

Data from 131 institutions in 45 countries spanning all World Bank income groups, found acute lymphoblastic lymphoma or acute lymphoblastic leukaemia (49·1%), extracranial solid tumours (24·2%), then other haematological malignancies were the most common cancer types.

The study, published in The Lancet Oncology, found most patients (82·9%) were receiving cancer-directed therapy at the time of their SARS-CoV-2 infection.

A third (35%) of patients were asymptomatic, 45% had mild or moderate disease, and 19.9% were considered severe or critical.

“The large proportion of asymptomatic patients underscores the need for aggressive infection control measures as these patients can pose infection risks to other patients and health-care providers,” the study authors said.

More than half of patients (55·8%) were reported to have an interruption in their cancer therapy.

Two-thirds (67.4%) of patients with 30-day follow-up were hospitalised, and 17.5% required admission or transfer to a higher level of care.

In a multivariable analysis, low-income or lower-middle-income (OR 5·8; p<0·0001) and upper-middle-income group (Or 1·6; p=0·0024), age 15–18 years (OR 1·6; p=0·013), absolute lymphocyte count of ≤300 cells/mm3 (OR 2·5; p<0·0001), absolute neutrophil count of ≤500 cells/mm3 (OR 1·8; p=0·0001), and intensive treatment (OR 1·8; p=0·0005) were associated with increased severity of infection.

“The finding of worse outcomes associated with lymphopenia and neutropenia suggests that it might be prudent to delay myelosuppressive and lymphocyte-depleting therapy during active infection if this is feasible in patients with other risk factors for severe disease.”

“Additionally, patients receiving or anticipated to receive intensive cancer-directed therapies should be prioritised for early access to vaccination, when appropriate, and for other supportive care interventions when resources are limited,” the study said.

Comorbidities were documented in 17·1% of patients, with receipt of high-dose steroids within the previous 14 days being the most common comorbidity (6·7%).

“Mortality due to COVID-19 within our cohort was 3·8% (50 of 1319), and although low, this figure is more than four times greater than that reported in published cohorts of general paediatric patients,” the study authors noted.

“These data could inform clinical practice guidelines and raise awareness globally that children and adolescents with cancer are at high-risk of developing severe COVID-19 illness,” they added.

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