Abstract

An understanding of the behavior of SARS-CoV-2 in pediatric hematology-oncology patients is essential to the optimal management of these patients during the COVID-19 pandemic. This study describes the characteristics and outcomes of COVID-19 disease in children with cancer or hematologic disorders treated at a large children’s hospital. A retrospective cohort study was conducted at Texas Children’s Cancer and Hematology Center from January 1, 2020 to September 30, 2020. All patients with a primary hematology-oncology diagnosis and SARS-CoV-2 positivity by reverse transcription polymerase chain reaction were identified. Clinical and laboratory data were obtained from the medical record. Descriptive analyses were performed to evaluate COVID-19-related outcomes and risk factors for severe disease in this population. We identified 109 patients with COVID-19 disease, including 52 hematology, 51 oncology, and 6 HSCT patients; median age was 10.3 years (IQR 4.4–15.9), and 58.7% were male. Seventy-four percent of the patients were managed in the outpatient setting. Patients with sickle cell disease were more likely to require hospitalization. ICU care was needed in 8% (n = 9) of the entire cohort, and mechanical ventilation was required in 6.4% (6 oncology patients, 1 hematology patient). COVID-19 contributed to the deaths of two cancer patients. No deaths occurred in hematology or HSCT patients. In conclusion, the risk of severe COVID-19 complications is slightly higher in pediatric hematology-oncology patients than in the general pediatric population but lower than initially feared. For most asymptomatic patients, primary disease management may continue as planned, but treatment decisions must be individualized.

摘要

了解 SARS-CoV-2 在儿科血液肿瘤患者中的行为对于在 COVID-19 大流行期间对这些患者进行最佳管理至关重要。本研究描述了在大型儿童医院接受治疗的癌症或血液系统疾病儿童 COVID-19 疾病的特征和结果。一项回顾性队列研究于 2020 年 1 月 1 日至 2020 年 9 月 30 日在德克萨斯儿童癌症和血液学中心进行。所有具有原发性血液肿瘤学诊断和逆转录聚合酶链反应呈 SARS-CoV-2 阳性的患者均被确定。从病历中获得临床和实验室数据。进行描述性分析以评估该人群中与 COVID-19 相关的结果和严重疾病的危险因素。我们确定了 109 名 COVID-19 患者，包括 52 名血液学患者、51 名肿瘤学患者和 6 名 HSCT 患者；中位年龄为 10.3 岁（IQR 4.4-15.9），58.7% 为男性。74% 的患者在门诊接受治疗。镰状细胞病患者更可能需要住院治疗。整个队列中有 8%（n = 9）需要 ICU 护理，6.4%（6 名肿瘤患者，1 名血液学患者）需要机械通气。COVID-19 导致两名癌症患者死亡。血液学或造血干细胞移植患者均未发生死亡。总之，儿科血液肿瘤患者发生严重 COVID-19 并发症的风险略高于一般儿科人群，但低于最初担心的风险。对于大多数无症状患者，