SARS-CoV-2 in Children with Cancer or Following Haematopoietic Stem Cell Transplant: An Analysis of 131 Patients

Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19

Résumé en anglais

Purpose : There are limited data on SARS-CoV-2 (COVID-19) infection in children with cancer or following hematopoietic stem cell transplant (HSCT). We describe severity and outcomes of SARS-COV-2 in these patients and identify factors associated with severe disease.

Methods : Multi-national, observational study of children (<19y) with cancer or HSCT and SARS-CoV-2 confirmed by polymerase chain reaction. COVID-19 was classified as asymptomatic, mild, moderate, severe, or critical (≥1 organ support). Exact polytomous regression was used to determine relationship between clinical variables and disease severity.

Results : One-hundred-and-thirty-one patients with COVID-19 across 10 countries were identified (median age 8y). Seventy-eight (60%) had leukemia/lymphoma, 48 (37%) solid tumour and 5 primary immunodeficiency and HSCT. Fever (71%), cough (47%) and coryza (29%) were the most frequent symptoms. The median duration of detectable virus was 16 days (range, 1-79d). Forty-nine patients (37%) were hospitalized for COVID-19 symptoms and 15 (11%) required ICU-level care. Chemotherapy was delayed/modified in 35%. COVID-19 was asymptomatic in 32% of patients, mild in 47%, moderate in 8%, severe in 4% and critical in 9%. In 124 patients (95%), a full recovery was documented and four (3%) died due to COVID-19. Any co-morbidity (odds ratio, 2.94; 95% CI, 1.81-5.21), any co-infection (1.74; 95% CI1.03-3.03) and severe baseline neutropenia (1.82; 95% CI1.13-3.09) were independently and significantly associated with increasing disease severity.

Conclusion : While most children with cancer had asymptomatic/mild disease, 13% had severe COVID-19 and 3% died. Co-morbidity, co-infection and neutropenia may increase the risk of severe disease. Our data may help management decisions in this vulnerable population.