NEW YORK (Reuters Health) – While most children and adolescents with cancer generally have mild illness during COVID-19 infection, 20% develop severe or critical illness, according to new data from the Global Registry of COVID-19 and Childhood Cancer.
The analysis, which covered 1,500 children with cancer and COVID-19 from 131 hospitals in 45 countries, found that 67% of the more than 1,300 with follow-up data were hospitalized and 18% required admission or transfer to a higher level of care for COVID-19.
It also found that 4% of children died due to COVID-19 infection, a rate four times higher than that reported among general pediatric patients, the study team reports in The Lancet Oncology.
“The results clearly and definitively show that children with cancer fare worse with COVID-19 than children without cancer,” corresponding author Dr. Sheena Mukkada with St. Jude Children’s Research Hospital, in Memphis, Tennessee, said in a statement.
Cancer care was also affected. Chemotherapy was withheld in 45% of patients receiving active therapy and some modification to cancer-directed therapy occurred in 56% of children on active therapy.
The researchers also identified several clinical patient factors, including lymphopenia and neutropenia, which were associated with more severe COVID-19 illness.
“The finding of worse outcomes associated with lymphopenia and neutropenia suggests that it might be prudent to delay myelosuppressive and lymphocyte-depleting therapy during active infection if this is feasible in patients with other risk factors for severe disease,” they suggest.
“Additionally, patients receiving or anticipated to receive intensive cancer-directed therapies should be prioritized for early access to vaccination, when appropriate, and for other supportive care interventions when resources are limited,” they add.
“This global collaboration helps clinicians make evidence-based decisions about prevention and treatment, which, unfortunately, remain relevant as the pandemic continues,” Dr. Mukkada said in the news release.
The Global Registry of COVID-19 in Childhood Cancer (https://bit.ly/3jAI7YK) was launched by St. Jude Children’s Research Hospital and the International Society of Pediatric Oncology (SIOP). The registry continues to enroll patients for around the world.
“The registry is based on voluntary reporting of laboratory-confirmed cases of SARS-CoV-2 infection in children and adolescents (<19 years) who have a current or past diagnosis of cancer or who have received a haematopoietic stem-cell transplantation,” the authors explain in their report.
“By working together to create this global registry, we have enabled hospitals around the world to rapidly share and learn how COVID-19 is affecting children with cancer,” SIOP President Dr. Kathy Pritchard-Jones said in the news release.
“The results are reassuring that many children can continue their cancer treatment safely, but they also highlight important clinical features that may predict a more severe clinical course and the need for greater vigilance for some patients,” Dr. Pritchard-Jones added.
Funding for the study was provided by the American Lebanese Syrian Associated Charities and the National Cancer Institute.
SOURCE: https://bit.ly/3kOb7LV The Lancet Oncology, online August 26, 2021.
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