ALL-206 Management and Outcome of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Centre Experience from a Developing Country

Context: Few developing countries have described the impact of coronavirus disease 2019 (COVID-19) on pediatric cancer patients. Most patients had a favorable outcome. The potential benefits of remdesivir (RDV) in pediatric oncology patients require further studies. Objective: Describe the management and outcome of COVID-19 in pediatric oncology patients. Design: Conducted from May to November 2020, this study included pediatric oncology patients with confirmed COVID-19. RDV was the antiviral therapy used. Setting: Pediatric oncology patients were treated at Children's Cancer Hospital Egypt, a specialized cancer center for pediatric oncology. Patients or Other Participants: This prospective study recruited 76 pediatric oncology patients with confirmed COVID-19 infection. Interventions: Allplex2019-nCoV Assay (Seegene, Seoul, South Korea) was used for Multiplex real-time PCR detection of SARS-CoV-2 according to manufacturer instructions. Main Outcome Measures: This study described the clinical course and management of SARS-CoV-2 infections in 76 pediatric oncology patients, detailing disease severity, duration to achieve a negative RT-PCR test, modifications made to protocols, and survival outcomes in patients who had been treated with RDV and those treated without it. Results: The median age of patients was 9 years. Sixty patients were on first-line treatment. Hematological malignancies constituted 86.8% of patients. Severe to critical infections affected 35.4% of patients. The most common symptom was fever (93.4%). Chemotherapy was delayed in 59.2% of patients and doses were modified in 30.2%. The 60-day overall survival (OS) stood at 86.8%, with mortalities occurring only among critical patients. Of 16 acute leukemia patients in the first induction therapy, 13 survived and 10 achieved complete remission. A negative RT-PCR within 2 weeks and improvement of radiological findings were statistically related to disease severity (P=.008 and .002, respectively). Better OS was associated with regression of radiological findings 30 days after infection (P=.002). Forty-five patients received RDV, and 42.1% had severe and critical forms of infection compared to 25.7% in the no-RDV group, yet OS was comparable in both groups. Conclusions: Most pediatric cancer patients with COVID-19 should have good clinical outcomes, except for patients with critical infections. Cancer patients can tolerate chemotherapy, including induction phase, alongside COVID-19 treatment. In severe and critical COVID-19, RDV might have a potential benefit.