High Risk Of Severe COVID-19 Illness In Children, Adolescents With Cancer

Author: By Shreeya Nanda, Senior medwireNews Reporter 

medwireNews: Data from a global hospital-based registry show that among children and adolescents with cancer and SARS-CoV-2 infection, a fifth developed severe or critical illness and the mortality rate, albeit low, was higher than that seen in the general paediatric population. 

The researchers point out, however, that despite the high incidence of severe and critical COVID-19 illness, “most patients recovered without advanced support needs.” 

They report on 1319 patients younger than 19 years who were included in the hospital-based Global Registry of COVID-19 in Childhood Cancer between 15 April 2020 and 1 February 2021 after receiving a laboratory-confirmed diagnosis of SARS-CoV-2 infection, and had a complete 30-day follow-up. Participants had a current or past diagnosis of cancer or had undergone haematopoietic stem cell transplantation. 

Just over a third (35.0%) of 1301 participants remained asymptomatic and 45.0% had a mild or moderate infection, while 19.9% had severe or critical illness, where critical illness was defined as organ dysfunction, intubation or death due to COVID-19, and severe illness as a requirement for a higher level of care or oxygen support greater than a regular nasal cannula or facemask. 

In all, 50 of the 83 deaths in the cohort were attributed to COVID-19, which gave a mortality rate of 3.8% for the infection. 

This rate “is considerably lower than the 13–28% reported in adults with cancer; however, it is disproportionately high compared with [the] 0.01–0.70% mortality in cohorts of general paediatric patients”, note Sheena Mukkada, from St Jude Children’s Research Hospital in Memphis, Tennessee, USA, and collaborators in The Lancet Oncology. 

Factors significantly associated with COVID-19 disease severity in multivariable analysis were an age of 15–18 years versus 1–9 years (odds ratio [OR]=1.6), intensive cancer treatment (OR=1.8) and absolute neutrophil and lymphocyte counts of 500 cells/mm3 or fewer and 300 cells/mm3 or fewer, respectively (ORs=1.8 and 2.5). 

Severe disease was also significantly more likely in participants from low- or lower middle-income countries and upper middle-income countries relative to those from high-income countries (ORs=5.8 and 1.6, respectively). 

Sheena Mukkada and colleagues found that 609 (55.8%) of the 1092 patients who were receiving anticancer treatment experienced some modification to therapy, including withholding of chemotherapy (80.0%), chemotherapy dose reduction (13.1%), and delays to surgery (6.7%) and radiotherapy (4.1%). 

And multivariable analysis showed that participants from upper middle-income countries and those with haematological malignancies excluding acute lymphoblastic leukaemia or lymphoma were significantly less likely to experience treatment modifications than their counterparts from high-income countries and those with solid tumours, respectively (OR=0.5 for both comparisons). 

By contrast, the presence of comorbidities and symptomatic COVID-19 were significantly associated with an increased likelihood of anticancer therapy modifications (ORs=1.6 and 1.8, respectively). 

“This report provides important data to support frontline clinicians making data-driven decisions about COVID-19 management, governments making prioritisation decisions, and health-care societies and organisations developing evidence-based guidelines”, say the study authors. 

But they add: “Our study design did not allow us to assess the drivers of interruption or its effect on overall survival or other important metrics, which merit further study.” 

Reference 

Mukkada S, Bhakta N, Chantada GL, et al. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. Lancet Oncol; Advance online publication 26 August 2021. doi: 10.1016/S1470-2045(21)00454-X