Most children and adolescents with cancer have mild COVID-19 disease and make a full recovery, a new study finds. But pediatric cancer patients with underlying health conditions, serious infections and low white blood cell counts were significantly more likely to have serious disease.
The study, led by the Murdoch Children’s Research Institute (MCRI), Peter MacCallum Cancer Center and Goethe University in Frankfurt, provides new insights into COVID-19 disease severity, shedding duration, symptoms and outcomes in children with cancer, will help inform treatment decisions.
The study, published in the European Journal of Cancer, involved 131 children under 19 with COVID-19 in 10 countries, including Australia, Germany, Brazil and Canada. The participants had either been diagnosed with cancer or had undergone a bone marrow stem cell transplant.
MCRI and Peter MacCallum Cancer Center associate professor Gabrielle Haeusler said there was: limited data before this study on SARS-CoV-2 infection in children with cancer or stem cell transplants.
The study reported that one-third of patients were asymptomatic, with 47 percent having mild cases overall, 8 percent moderate cases, 4 percent severe and 9 percent critical. It found that 37 percent were hospitalized, 11 percent required ICU care and four died as a result of COVID-19. But in 95 percent of the cases, the patients made a full recovery.
Associate Professor Haeusler, also a physician at the Royal Children’s Hospital, said increased severity of childhood cancer COVID-19 was detected in children with co-morbidities, severe infections (usually bacterial co-infections) and low white blood cell counts, a marker of immunosuppression, emphasizing the need for increased awareness among healthcare professionals.
In patients receiving active treatment, chemotherapy was delayed or doses adjusted in one third of the cases. Importantly, changes in treatment were not significantly associated with a reduced risk of severe COVID-19. There was no difference in the percentage of patients with symptomatic infection who received cancer treatment and those who completed treatment.
The most common COVID-19 symptoms were fever, cough, runny nose, and gastro. The median duration of virus detection in the patients was 16 days. However, in some patients, the virus was detected up to 80 days after the initial infection.
Goethe University Professor Thomas Lehrnbecher said the COVID-19 pandemic poses major challenges for cancer patients.
“While data emerged early in the pandemic on the increased risk of worse outcomes and death for adult cancer patients with COVID-19, the impact of the disease in children with cancer was less clear,” he said.
“Understanding the impact of COVID-19 in children with cancer is critical to informing pediatric care pathways, including adjusting chemotherapy regimens and isolation restrictions.”
Children over the age of 12 with cancer or a history of cancer are a priority group for an mRNA COVID-19 vaccine.
Associate professor Haeusler said that although the study identified some predictors of serious illness, prevention was still our best defense.
We found that most COVID-19 transmissions took place in the family home. In addition to the vaccination of treating healthcare workers, vaccination of household and regular family contacts against COVID-19 is a crucial protection measure.
Continued surveillance is also critical to monitor vaccine efficacy and the impact of emerging COVID-19 variants in this vulnerable population.”
Gabrielle Haeusler, Associate Professor, MCRI
Murdoch Childrens Research Institute
Haeusler, GM, et al. (2021) SARS-CoV-2 in children with cancer or after hematopoietic stem cell transplantation: an analysis of 131 patients. European cancer magazine. doi.org/10.1016/j.ejca.2021.09.027.