Study finds children with blood cancers at greatest risk for severe COVID-19

One in five children with cancer had severe or critical COVID-19, and 1 in 25 died, according to health data gathered in 45 countries.

Children with cancer were more likely to experience severe COVID-19 symptoms than other children, according to a first-of-its-kind worldwide study.

One in 5 children with cancer had severe or critical COVID-19, and 1 in 25 died, according to health data gathered in 45 countries.

In the general population, severe COVID-19 has been reported in only 1% to 6% of children and adolescents, including those who tested positive while hospitalized for another medical issue.

Looking at 1,500 cancer patients under age 19 who either have cancer or have received a stem cell transplant, the researchers found children and adolescents with blood cancers were at the greatest risk for severe COVID-19.

“An even bigger factor was the intensity of the treatment the children were receiving,” said Mustafa Barbour, M.D., a pediatric oncologist with Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine. “Patients receiving induction treatment for leukemia or any therapy for acute myeloid leukemia fared the worst.”

The study, “Global Characteristics and Outcomes of SARS-CoV-2 Infection in Children and Adolescents with Cancer (GRCCC): A Cohort Study,” published in The Lancet, was conducted from April 2020 to February 2021 — before the omicron variant and during the time when the delta variant began spreading across the globe.

Even before this study, children and adolescents with cancer or who have received a stem cell transplant already were considered at high risk for severe illness or death if they were infected by a respiratory virus.

Children in low- and middle-income countries were more likely to experience severe COVID-19 symptoms than children from wealthy countries, according to the study. The reasons are unclear, but could be related to the COVID-19 diagnosis coming later, delays getting to the hospital, disruptions of medical supplies or other issues.

COVID-19 also disrupted anti-cancer treatments for more than half of the children who were receiving treatment when they became sick with COVID-19. It’s unclear how the disruption will affect them in the long term.

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Cancer therapy can continue for COVID-19 patients in most cases

The study concluded that, in most cases, cancer therapy can continue without interruption, and no antiviral therapy for COVID-19 is needed. However, physicians should consider delaying myelosuppressive or lymphocyte-depleting therapy during active COVID-19 infection, if possible.

When appropriate, the study added, patients receiving or scheduled to receive intensive cancer-directed therapies should be prioritized for early access to a vaccine or other health care resources, if supplies are limited.

Previous, smaller studies found children and adolescents with cancer tended to have mild cases of COVID-19.

“This study makes it very clear that children and their families should exercise caution and inform their physician as soon as they experience symptoms or test positive,” Dr. Barbour said.


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