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COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies
Background: COVID-19 in adults with cancer results in substantial rates of severe infection (>25%) and death (13%) that are more than two-fold those in adults without cancer. Data from a few cohorts of COVID-19 in children with cancer, most of whom had leukemia, suggest low hospitalization rates...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society of Hematology. Published by Elsevier Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701557/ http://dx.doi.org/10.1182/blood-2021-151390 |
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author | Parker, Rebecca S Malvar, Jemily Doan, Andrew Aguayo-Hiraldo, Paibel Parekh, Chintan |
author_facet | Parker, Rebecca S Malvar, Jemily Doan, Andrew Aguayo-Hiraldo, Paibel Parekh, Chintan |
author_sort | Parker, Rebecca S |
collection | PubMed |
description | Background: COVID-19 in adults with cancer results in substantial rates of severe infection (>25%) and death (13%) that are more than two-fold those in adults without cancer. Data from a few cohorts of COVID-19 in children with cancer, most of whom had leukemia, suggest low hospitalization rates (<10%) for COVID-19 in pediatric cancer. However, among pediatric patients with hematological cancers, there is a paucity of data regarding COVID-19 in adolescent and young adults (AYA) or recipients of hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor T-cell (CAR-T) therapies. This study aims to define outcomes in COVID-19 in children and AYA with hematologic cancers receiving HSCT, CAR-T, or chemotherapy. Methods: We retrospectively reviewed medical records of patients aged 25 years and younger treated at Children's Hospital Los Angeles for a hematological cancer between March 2020 and March 2021. These patients underwent COVID-19 nasopharyngeal (NP) PCR prior to any sedation, hospitalization, or in case of symptoms suggestive of COVID-19 infection. COVID-19 related hospitalizations were defined as hospital stays due to COVID-19 manifestations that necessitated inpatient care and excluded those that were solely for febrile neutropenia. Results: We identified a cohort of 56 patients with PCR positive COVID-19 infection. The infected cohort had a median age of 11.5 years (2-24 years). A majority of the cohort was of Hispanic ethnicity (n=38, 67%), and 40% (n=22) were overweight or obese. 53 had leukemia (49 lymphoid, 2 acute myeloid, and 2 chronic myeloid), and 3 had lymphoma. Anti-cancer therapy included chemotherapy only (n=40), CAR-T (n=6), HSCT (n=6) or both HSCT and CAR-T (n=4).The median time from malignancy diagnosis to COVID-19 for the chemotherapy cohort was 11 months (0-119 months.) Median time from HSCT or CAR-T was 15 months (2-59 months.) 29 patients were in a highly immunosuppressive phase of anti-cancer therapy. 44 (79%) had symptomatic COVID-19. 18 (32%) patients required inpatient care for COVID-19 (COVID-19 related hospitalization.) 6 had critical/severe, 6 had moderate, and 44 had mild infection (WHO Criteria.) For patients with non-severe infection, the reasons for hospitalization were dehydration and tachycardia requiring intravenous fluids. All patients with critical/severe infection developed hypoxia; 5 required intensive care admission. One required invasive ventilation. Two patients had multisystem inflammatory syndrome; both had received CAR-T. Only one patient developed a new thrombus during COVID-19 infection. COVID-19 therapies included Remdesivir (n=9), steroids (n=5), convalescent plasma (n=3), azithromycin (n=2), hydroxychloroquine (n=1), and monoclonal antibodies (n=1.) 4 patients underwent multiple (2-6) COVID related hospitalizations. Factors associated with a higher risk for COVID related hospitalization included recent steroid exposure (p=0.006), neutropenia (p=0.04), and lymphopenia (p=0.005.) Obesity or HSCT were not associated with a higher risk for hospitalization. 3 of 6 CAR-T recipients with B-cell aplasia had severe/critical infection, one of whom required 6 hospitalizations for COVID-19 and was COVID-19 PCR positive for 212 days. COVID-19 resulted in chemotherapy delays in 11 of 40 patients (delays ranged 2-39 days, median=14 days.) Conclusions: While there was no mortality from COVID-19, in contrast to other pediatric cancer studies, several patients required recurrent hospitalizations, and there was a substantially higher COVID-19 related hospitalization rate in our cohort. Differences in demographics and immunosuppression between our and other studies may account for this discrepancy. Neutropenia, lymphopenia, and exposure to steroids were predictive of higher risk for hospitalization. Our data suggest higher severity of COVID-19 infections in CAR-T recipients with B-cell aplasia raising the possibility of an increased risk for COVID-19 morbidity in the setting of hypogammaglobulinemia. In contrast to studies reported from the general population, obesity was not associated with worse COVID-19 outcomes in our cohort of pediatric patients with cancer. Ongoing studies entail collection of retrospective clinical data and prospective clinical and immune biomarker data from additional patients. DISCLOSURES: Parekh: Amgen: Other: spouse is employee and owns stock; PLUTO: Other: early investor. |
format | Online Article Text |
id | pubmed-8701557 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American Society of Hematology. Published by Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-87015572021-12-28 COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies Parker, Rebecca S Malvar, Jemily Doan, Andrew Aguayo-Hiraldo, Paibel Parekh, Chintan Blood 905.Outcomes Research-Lymphoid Malignancies Background: COVID-19 in adults with cancer results in substantial rates of severe infection (>25%) and death (13%) that are more than two-fold those in adults without cancer. Data from a few cohorts of COVID-19 in children with cancer, most of whom had leukemia, suggest low hospitalization rates (<10%) for COVID-19 in pediatric cancer. However, among pediatric patients with hematological cancers, there is a paucity of data regarding COVID-19 in adolescent and young adults (AYA) or recipients of hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor T-cell (CAR-T) therapies. This study aims to define outcomes in COVID-19 in children and AYA with hematologic cancers receiving HSCT, CAR-T, or chemotherapy. Methods: We retrospectively reviewed medical records of patients aged 25 years and younger treated at Children's Hospital Los Angeles for a hematological cancer between March 2020 and March 2021. These patients underwent COVID-19 nasopharyngeal (NP) PCR prior to any sedation, hospitalization, or in case of symptoms suggestive of COVID-19 infection. COVID-19 related hospitalizations were defined as hospital stays due to COVID-19 manifestations that necessitated inpatient care and excluded those that were solely for febrile neutropenia. Results: We identified a cohort of 56 patients with PCR positive COVID-19 infection. The infected cohort had a median age of 11.5 years (2-24 years). A majority of the cohort was of Hispanic ethnicity (n=38, 67%), and 40% (n=22) were overweight or obese. 53 had leukemia (49 lymphoid, 2 acute myeloid, and 2 chronic myeloid), and 3 had lymphoma. Anti-cancer therapy included chemotherapy only (n=40), CAR-T (n=6), HSCT (n=6) or both HSCT and CAR-T (n=4).The median time from malignancy diagnosis to COVID-19 for the chemotherapy cohort was 11 months (0-119 months.) Median time from HSCT or CAR-T was 15 months (2-59 months.) 29 patients were in a highly immunosuppressive phase of anti-cancer therapy. 44 (79%) had symptomatic COVID-19. 18 (32%) patients required inpatient care for COVID-19 (COVID-19 related hospitalization.) 6 had critical/severe, 6 had moderate, and 44 had mild infection (WHO Criteria.) For patients with non-severe infection, the reasons for hospitalization were dehydration and tachycardia requiring intravenous fluids. All patients with critical/severe infection developed hypoxia; 5 required intensive care admission. One required invasive ventilation. Two patients had multisystem inflammatory syndrome; both had received CAR-T. Only one patient developed a new thrombus during COVID-19 infection. COVID-19 therapies included Remdesivir (n=9), steroids (n=5), convalescent plasma (n=3), azithromycin (n=2), hydroxychloroquine (n=1), and monoclonal antibodies (n=1.) 4 patients underwent multiple (2-6) COVID related hospitalizations. Factors associated with a higher risk for COVID related hospitalization included recent steroid exposure (p=0.006), neutropenia (p=0.04), and lymphopenia (p=0.005.) Obesity or HSCT were not associated with a higher risk for hospitalization. 3 of 6 CAR-T recipients with B-cell aplasia had severe/critical infection, one of whom required 6 hospitalizations for COVID-19 and was COVID-19 PCR positive for 212 days. COVID-19 resulted in chemotherapy delays in 11 of 40 patients (delays ranged 2-39 days, median=14 days.) Conclusions: While there was no mortality from COVID-19, in contrast to other pediatric cancer studies, several patients required recurrent hospitalizations, and there was a substantially higher COVID-19 related hospitalization rate in our cohort. Differences in demographics and immunosuppression between our and other studies may account for this discrepancy. Neutropenia, lymphopenia, and exposure to steroids were predictive of higher risk for hospitalization. Our data suggest higher severity of COVID-19 infections in CAR-T recipients with B-cell aplasia raising the possibility of an increased risk for COVID-19 morbidity in the setting of hypogammaglobulinemia. In contrast to studies reported from the general population, obesity was not associated with worse COVID-19 outcomes in our cohort of pediatric patients with cancer. Ongoing studies entail collection of retrospective clinical data and prospective clinical and immune biomarker data from additional patients. DISCLOSURES: Parekh: Amgen: Other: spouse is employee and owns stock; PLUTO: Other: early investor. American Society of Hematology. Published by Elsevier Inc. 2021-11-23 2021-12-24 /pmc/articles/PMC8701557/ http://dx.doi.org/10.1182/blood-2021-151390 Text en Copyright © 2021 American Society of Hematology. Published by Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | 905.Outcomes Research-Lymphoid Malignancies Parker, Rebecca S Malvar, Jemily Doan, Andrew Aguayo-Hiraldo, Paibel Parekh, Chintan COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies |
title | COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies |
title_full | COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies |
title_fullStr | COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies |
title_full_unstemmed | COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies |
title_short | COVID-19 in Children, Adolescents and Young Adults with Hematological Malignancies |
title_sort | covid-19 in children, adolescents and young adults with hematological malignancies |
topic | 905.Outcomes Research-Lymphoid Malignancies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701557/ http://dx.doi.org/10.1182/blood-2021-151390 |
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