In a U.S. cohort study reported in JAMA Oncology, Martin et al described the clinical course and potential factors associated with post–COVID-19 multisystem inflammatory syndrome in children with cancer also infected with COVID-19. Post–COVID-19 multisystem inflammatory syndrome is a hyperinflammatory disease associated with a constellation of clinical features, including fever, gastrointestinal symptoms, mucocutaneous changes, myocardial dysfunction, and acute kidney injury.
Study Details
The study included data from patients in the U.S. Pediatric Oncology COVID-19 Case Consortium registered between April 1, 2020, and May 18, 2022. Children (aged < 21 years) with cancer infected with COVID-19 while receiving cancer treatment or within 1 year of completing treatment were characterized based on development of multisystem inflammatory syndrome.
Key Findings
Among 2,035 children with cancer and COVID-19, 24 (1.2%) developed multisystem inflammatory syndrome. Characteristics of these 24 patients were compared with 96 matched controls without multisystem inflammatory syndrome.
COVID-19 infection occurred at a median age of 12.5 years (interquartile range [IQR] = 5.5–17.1 years) in those with multisystem inflammatory syndrome and 11 years (IQR = 6–16 years) among matched controls (P = .86).
Among the 24 children with multisystem inflammatory syndrome, 20 (83.3%) had hematologic cancer, 16 (66.7%) were publically insured, 13 (54.2%) were Hispanic, and 12 (50.0%) had at least one noncancer comorbidity. No significant differences between children with multisystem inflammatory syndrome and matched controls were observed for age, sex, race, ethnicity, insurance, cancer diagnosis, transplantation status, disease status, absolute lymphocyte count, or presence of at least one comorbidity. On multivariate analysis, children with a comorbidity were more likely to develop multisystem inflammatory syndrome (odds ratio [OR] = 2.5, 95% CI = 1.1–5.7).
Among children with multisystem inflammatory syndrome, 24 (100%) were admitted to the hospital and 13 (54.2%) to the intensive-care unit (ICU); cancer therapy was changed in 15 (62.5%). On multivariate analysis, compared with matched controls, children with multisystem inflammatory syndrome were significantly more likely to have symptoms classified as systemic (OR = 4.7, 95% CI = 1.4–15.8) or gastrointestinal (OR = 5.0, 95% CI = 1.7–14.6), to be admitted to the hospital (OR = 42.9, 95% CI = 7.1–258) or ICU (OR = 11.4, 95% CI = 3.6–36.4), and to have changes in cancer therapy (OR = 24.9, 95% CI = 6.5–94.8). COVID-19 contributed to death in five children with multisystem inflammatory syndrome (20.1%) vs one control patient (1.0%; P = .002).
The investigators concluded, “In this cohort study among children with cancer and COVID-19, those with multisystem inflammatory syndrome had a more severe clinical course than those without multisystem inflammatory syndrome. The risk of multisystem inflammatory syndrome and its severity are important to consider as clinicians monitor patients with COVID-19. These findings can inform their conversations with families regarding COVID-19 risks and the benefits of prevention strategies that are pharmacologic (vaccination) and nonpharmacologic (masking), as well as treatment (antivirals, monoclonal antibodies).”
Emily E. Johnston, MD, MS, of The University of Alabama at Birmingham, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
