Advice on COVID-19 vaccination for children with cancer: new working group

Paediatric oncologists have formed a working group with other specialists to try address the paucity of data regarding COVID-19 vaccination in children with cancer.

The Global COVID-19 Observatory and Resource Center for Childhood Cancer, based at the St Jude Children’s Research Hospital in Memphis, USA, has set up the COVID-19 Vaccine Working Group on Pediatric Oncology, a multidisciplinary group of oncologists, infectious disease physicians and nurses representing all major regions of the world and several countries.

It says there has been an avalanche of information (and misinformation) surrounding COVID-19 vaccines, and yet very few studies have been done specifically in children with cancer.

The group says it hopes to act as a hub to collate resources to help health care providers who “face the difficult task to make the decision whether or not to vaccinate these at-risk children.”

The move has been welcomed by paediatric oncologists in Australia, who say they currently have to base vaccination decisions on the assumption that children with cancer will mount protective immune responses to COVID-19 vaccine based on the same factors considered for other vaccines such as influenza.

These factors might include the number of doses received, whether treatment is being delivered for a solid or hematological malignancy and lymphocyte count at the time of vaccination, said Dr Rishi Kotecha of the Department of Clinical Haematology, Oncology and Bone Marrow Transplantation, Perth Children’s Hospital.

“Given that the patterns of response are reflective of host immunity, similar outcomes are likely to be found following COVID-19 vaccination in children with cancer, suggesting that optimisation of outcome could be achieved by timing immunisation at the furthest point from the immunosuppressing effect of cytotoxic treatment during a given cycle,” he wrote in Pediatric Blood and Cancer journal

“In addition, a specific consideration to vaccination of children with acute lymphoblastic leukemia is the presence of polyethylene glycol (PEG) as a stabilising component of mRNA COVID-19 vaccines, necessitating the development and validation of strategies to mitigate risk for children with a prior history of hypersensitivity to PEG-asparaginase,” he added.

Dr Kotecha said that as COVID-19 vaccines become licensed for use in children and adolescents, there will be a need to develop clinical trials in children with cancer to provide best evidence.

However, given that access to trials will not be universal and the length of time required to conduct a trial, it will be essential for global collation of data for children with cancer who are vaccinated outside of a clinical trial setting. This should include a minimum clinical dataset, with reporting of safety data, including adverse events such as myocarditis and pericarditis, and history of COVID-19 infection prior to and postvaccination, he suggested.

“This could be best facilitated by platforms such as the Global COVID-19 Observatory and Resource Center for Childhood Cancer, which continues to provide an invaluable resource on COVID-19 for health care professionals treating children with cancer,” concluded Dr Kotecha.

On 23 August ATAGI recommended vaccination against COVID-19 for all adolescents from 12 years of age, extending the recommendation for those aged 16 years and older.

Currently only a two-dose schedule using Comirnaty (Pfizer) is registered for use in Australia in this age group, but ATAGI says recommendations on the use of Spikevax (Moderna) for adolescents will be finalised soon.

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