COVID-19 Risk in Pediatric Patients Receiving Treatment for Acute Lymphoblastic Leukemia or Lymphoma

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In a retrospective case series reported in JAMA Network Open, Hashmi et al found that more than one-third of pediatric patients receiving treatment for newly diagnosed acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LL) developed COVID-19 infection during a recent 2-year period.

Study Details  

The study involved 308 patients aged 1 to 18 years who were receiving chemotherapy for newly diagnosed ALL/LL at St. Jude Children’s Research Hospital and affiliate sites between March 30, 2020, and June 20, 2022. All patients were screened for COVID-19 infection at least weekly, at symptom onset, and after known exposure to SARS–CoV-2.

Key Findings

During the 27-month study period, COVID-19 infection developed in 110 patients (36%). Median age at diagnosis was 8.2 years (interquartile range = 5.3–14.5 years). Of those diagnosed with COVID-19, 101 (92%) were in the continuation/maintenance phase of chemotherapy.

Severe disease was infrequent, occurring in seven patients (6%); severe disease was associated with older age, higher white blood cell counts at ALL/LL diagnosis, lower absolute lymphocyte counts at COVID-19 diagnosis, abnormal chest imaging findings, and SARS–CoV-2 reinfection. Intensive care unit admission was required in four patients (3.6%). Serious thrombotic events occurred in two patients, consisting of pulmonary embolism in one and cerebral venous sinus thrombosis in one. No multisystem inflammatory syndrome was observed. No deaths due to COVID-19 infection occurred.

SARS–CoV-2 reinfection occurred in 11 patients (10%); reinfection was associated with older age and receipt of standard- or high-risk vs low-risk ALL/LL therapy.

Chemotherapy interruptions due to COVID-19 infection occurred in 96 patients (87%); interruptions were longer among those with severe COVID-19 disease, SARS–CoV-2 reinfection, and COVID-19 diagnosis during the pre–Omicron variant period vs the post-Omicron period (after December 27, 2021).

The investigators concluded, “In this case series of COVID-19 in pediatric patients with acute lymphoblastic leukemia/lymphoblastic lymphoma, 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.”

Hiroto Inaba, MD, PhD, of the Department of Oncology, St. Jude Children’s Research Hospital, Memphis, is the corresponding author for the JAMA Network Open article.

Disclosure: The study was supported by the National Cancer Institute and the American Lebanese Syrian Associated Charities. For full disclosures of the study authors, visit

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