ALL-098: COVID-19 in Children with Cancer: What We Learned from the First Wave

CONTEXT: COVID-19 is associated with morbidity and mortality in children with cancer, who are treated mainly in outpatient settings, where hospital visits are unavoidable for appropriate delivery of therapy, increasing their exposure risk to SARS-CoV-2. OBJECTIVE: To measure the frequency of SARS-CoV-2 infection among hospitalized children with cancer and to detect the associated clinical manifestations and outcomes. DESIGN: A prospective, nonintervention study recruited all hospitalized children with cancer with confirmed SARS-CoV-2 between mid-April and mid-June 2020 (NCT04404244). SETTING: The study was carried out at a tertiary Pediatric Hematology Oncology Department at Ain Shams University in Egypt. METHODOLOGY: On admission and upon suspicion of COVID-19, patient clinical report forms, including demographic data, clinical assessments, epidemiological data (history of contact with a COVID-19 case), underlying oncologic disorders, and cause of admission, were completed. Baseline laboratory investigations, including complete blood count, C-reactive protein, serum ferritin, lactate dehydrogenase, and D-dimer, were performed. COVID-19 was confirmed by SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test by nasopharyngeal swab. Chest radiograph and/or high-resolution computed tomography (HRCT) chest scan was performed. RESULTS: Over the study course, 61 children with cancer were admitted: 42 (68.9%) had acute lymphoblastic leukemia (ALL), 4 (6.5%) had lymphoma, and 15 patients had other malignancy. Fifteen were diagnosed with SARS-CoV-2. Most had hematological malignancies: 10 (76.9%) had ALL, 1 (6.7%) had acute myeloid leukemia, and 2 (13.4%) had lymphoma. Their mean age was 8.3 ± 3.5 years. Initially, 10 (66.7%) were asymptomatic, and 5 (33.3%) were symptomatic with fever and/or cough. Baseline laboratory tests other than SARS-CoV-2 RT-PCR were not diagnostic; the mean absolute lymphocyte count was 8.7 ± 2.4 × 10(9)/L. C-reactive protein was mildly elevated in most of the patients. Imaging was performed in 10 (66.7%) patients, with significant radiologic findings detected in 4 (40%) patients. Treatment was mainly supportive with antibiotics, as per the febrile neutropenia protocol and local Children’s Hospital guidance for management of COVID-19 in children. CONCLUSIONS: Pediatric cancer patients with COVID-19 were mainly asymptomatic or with mild symptoms. A high index of suspicion and regular screening with nasopharyngeal swabs in asymptomatic hospitalized cancer patients is recommended.