Children With Cancer At Higher Risk for Severe Illness from COVID-19

About 20% of pediatric patients with cancer infected with COVID-19 had severe disease, according to data published in The Lancet Oncology. In addition, deaths from the infection were proportionally higher in this patient population compared to the general pediatric population, providing evidence that children with cancer are at higher risk of developing serious illness from COVID-19.1

Of the 1,319 evaluable children with cancer studied in a cohort study, 259 (19.9%) experienced severe or critical illness due to COVID-19, compared to only 1% to 6% in the general pediatric population. Fifty (3.8%) cancer patients died from causes related to the infection. In addition, 609 (55.8%) of the 1092 patients actively receiving cancer-related therapy required treatment adjustments due to COVID-19 infection.

“The results clearly and definitively show that children with cancer do worse with COVID-19 than children without cancer,” said corresponding author Sheena Mukkada, MD, an assistant member of the St. Jude Departments of Global Pediatric Medicine and Infectious. Diseases, in a press release.2 “This global collaboration helps clinicians make evidence-based decisions about prevention and treatment, which unfortunately remain relevant as the pandemic continues.”

While previous studies have examined the impact of COVID-19 on adult cancer patients, there is little data on the impact of the infection on pediatric cancer patients and no clinical risk factors for COVD-19 have been identified in this patient population. As such, the St. Jude Global Program at St. Jude Children’s Research Hospital and the International Society of Pediatric Oncology established the Global COVID-19 Observatory and Resource Center for Childhood Cancer to collect data on disease severity and risk factors. in pediatric patients with cancer or those who have had a haematopoietic stem cell transplant.

In April 2020, researchers launched the St. Jude Global and International Society of Pediatric Oncology Global Registry of COVID-19 in Childhood Cancer, collecting data on confirmed cases of COVID-19 from 131 institutions in 45 countries. Patients included in the registry were under 19 years of age, had a current or previous diagnosis of cancer, or had undergone a hematopoietic stem cell transplant.

The patient data collected includes: oncology diagnosis, treatment stage, non-oncology co-morbidities, imaging findings, anatomical location of infection, and COVID-19 targeted therapy. In addition, outcome data collected for the study included: need for a higher level of care, respiratory support requirements, laboratory and clinical status of the COVID-19 infection, vital status, and interruptions in cancer-targeted treatment.

Of the 1500 patients from whom data were collected, the median age was 8 years (range 4-13), and the majority were 1 to 9 years old (54.9%), geographically located in the

America (56.5%) and men (59.4%). In addition, 49.1% of patients had acute lymphoblastic leukemia or acute lymphoblastic lymphoma, 24.2% had solid tumor cancer, 17.7% had other haematological malignancies, 8.4% had tumors of the central nervous system. Eight (0.5%) had undergone hematopoietic stem cell transplantation.

Most of the patients studied had received cancer-targeted therapy (82.9%) and 1171 of the 1,203 (97.3%) of those receiving chemotherapy received their last dose within 30 days of COVID-19 infection.

Of the 1,319 patients evaluable at 30 days of follow-up, 45.0% had mild to moderate symptoms, 35.0% were asymptomatic, and 19.9% ​​had severe or critical symptoms. A majority of those receiving active cancer treatment (n = 609/1092; 55.8%) had to adjust their treatment because of a COVID-19 infection. In addition, 889 of these patients (67.4%) were hospitalized with ward status or higher.

Of the 83 deaths reported in the study, 50 were due to COVID-19 infection (60.2%) and 33 were from other causes (39.8%). Among patients who died due to COVID-19, the median time to death was 8 days (range, 3-14).

Higher rates of severe or critical symptoms of COVID-19 infection were reported in low- or lower-middle-income countries (41.7%) compared to upper-middle (16.5%) or high-income countries (7.4%).

Additional data from a univariate logistic regression analysis showed that variables such as income group, cancer type, age, absolute lymphocyte count, absolute neutrophil count, presence of co-morbidities, and treatment intensity were associated with higher rates of serious or critical illness. In addition, the results of a multivariate analysis showed that low or lower middle incomes, upper middle incomes, ages 15 to 18 years, an absolute lymphocyte count of 300 or fewer cells per mm3, an absolute neutrophil count of 500 or fewer cells per mm3, and intensive treatment were associated with increased severity of COVID-19 infection.

“Understanding a global crisis like COVID-19 requires our entire pediatric cancer community around the world to come together to respond,” said senior author Carlos Rodriguez-Galindo, MD, director of St. Jude Global, in a press release. “The impact of this disease has been felt in all corners of the world, but especially in low- and middle-income countries compared to high-income countries. There are critical differences based on where a child lives. This registry is a tool that helps us understand what that means for children with cancer everywhere.”


Mukkada S, Bhakta N, Chantada GL, et al. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. Lancet Oncol. Published online Aug 26, 2021. doi:10.1016/S1470-2045(21)00454-XCOVID-19 in children with cancer: severe disease and impaired treatment. news item. St Jude Children’s Research Hospital. August 26, 2021. Accessed August 30, 2021.

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