Most children and adolescents with cancer have mild COVID-19 disease and make a full recovery, a new study by Haeusler et al in the European Journal of Cancer has found. But pediatric patients with cancer and underlying health conditions, severe infections, and low white blood cell counts were significantly more likely to have severe disease.
The study, led by researchers at Murdoch Children’s Research Institute (MCRI) and Peter MacCallum Cancer Centre in Australia and Goethe University in Germany, provides new insights into COVID-19 disease severity, duration of shedding, symptoms, and outcomes in children with cancer.
The research involved 131 children aged under 19 years with COVID-19 across 10 countries including Australia, Germany, Brazil, and Canada. The participants either had a diagnosis of cancer or had undergone a bone marrow stem cell transplant.
Gabrielle Haeusler, MBBS, PhD, Associate Professor at MCRI and Peter MacCallum Cancer Centre, said there were limited data before this study on SARS–CoV-2 infection in children with cancer or stem cell transplants.
Study Findings
The study reported one-third of patients were asymptomatic, with 47% overall having mild cases, 8% moderate cases, 4% severe, and 9% critical. It found 37% of patients were hospitalized, 11% required ICU care, and four died due to COVID-19. But in 95% of cases, the patients made a full recovery.
Dr. Haeusler said increased COVID-19 severity in children with cancer was detected in those with comorbidities, severe infections (mostly bacterial co-infections), and low white blood cell counts, a marker of immune suppression, emphasizing the need for a heightened awareness among health-care staff. For patients on active treatment, chemotherapy was delayed or doses were modified in one-third of cases. Importantly, changes in treatment were not significantly associated with a reduced risk of severe COVID-19. There was no difference in the proportion of patients with symptomatic infection who were having cancer treatment and those who had completed treatment.
The most frequent COVID-19 symptoms were fever, cough, runny nose, and gastrointestinal symptoms. The median duration of virus detection in the patients was 16 days. However, the virus was detected up to 80 days after initial infection in some patients.
Prevention Is the Best Defense
Thomas Lehrnbecher, MD, Professor of Pediatrics at Goethe University, said the COVID-19 pandemic had posed great challenges for patients with cancer.
“While data emerged early in the pandemic about the increased risks 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. “An understanding of the impact of COVID-19 in children with cancer is critical to informing pediatric care pathways including modifying chemotherapy regimens and isolation restrictions.”
Dr. Haeusler said that while the study identified some predictors of severe illness, prevention is still our best defense. “We found most COVID-19 transmissions occurred within the family home. In addition to the vaccination of treating health-care workers, vaccination of household and regular family contacts against COVID-19 is a crucial protective measure,” she said.
“Ongoing surveillance is also critical to monitor vaccine efficacy and impact of emerging COVID-19 variants in this vulnerable population.”
Dr. Haeusler is the corresponding author for the European Journal of Cancer article.
Disclosure: For full disclosures of the study authors, visit www.ejcancer.com.
