Abstract

Introduction

Guatemala reported the first confirmed SARS-CoV-2 case on March 13^th 2020. Up to now, more than 140,000 confirmed cases have been documented, with 8% of them being <20 years-old. The impact of COVID-19 in pediatric cancer in not well known, even though pediatric oncological institutions did some initial recommendations, this new disease still represents a challenge in this population. The objective of the report is to describe the moderate-severe cases of COVID-19 in pediatric cancer during the first 8 months of the pandemic in the Unidad Nacional de Oncologia Pediatrica (UNOP).

Methods

This is a descriptive, prospective report of pediatric cancer patients <20 years-old and SARS-CoV-2 infection confirmed by nasopharyngeal swab with PCR technique at UNOP from May to December 2020. The SARS-CoV-2 test was performed to all patients who developed symptoms of infection or as screening in patients who were admitted to UNOP regardless of symptoms. Information about sex, age, primary oncological diagnosis, confirmed coinfections and treatment received at time of COVID-19 was collected. Moderate illness was considered if the patient required supplemental oxygen and severe illness if admitted to Intensive Care Unit -ICU- secondary to COVID-19.

Results

Two hundred one patients with pediatric cancer with the SARS-CoV-2 infection were confirmed. Sixty four percent were male (n=128), median of age was 9.5 years (5-m to 18-y). The primary oncologic diagnosis was leukemia 65% (n=129), and other solid tumors 35% (n=72), 5% (n=10) of patients were in palliative care. In leukemia patients, 40% were receiving induction therapy (n=51), 25% consolidation (n=32), and 19% maintenance (n=25). The most common initial symptom was fever in 32% (n=64) and 33% were asymptomatic (n=67). Twenty two percent developed moderate disease (n=44) and 13% severe disease (n=26).A total of 13 patients died during COVID-19 period (6%) and 7 of them died receiving active treatment (3%). The risk of developing moderate-severe disease was not higher in leukemia patients compared to patients with other tumors who were receiving intense chemotherapy (OR=0.7), but there might be a higher risk of death (OR=1.41). In patients with leukemia, the risk of developing moderate-severe disease was higher for patients receiving induction therapy compared with those in consolidation (OR=6.7) or maintenance (OR=3.04). Mortality risk seems to be higher in patients with leukemia during induction therapy (OR=1.94). Confirmed coinfections correlated with higher risk of severe illness (OR=1.95) and death during the COVID-19 period (OR=5.2).

Conclusions

The mortality due to COVID-19 in pediatric cancer is low and could be related to coinfections or intensive chemotherapy. Important limitation of our report is the lack of analysis of underlying clinical conditions in moderate-severe disease (neutropenia or other comorbidities), factors that could have an impact on our data analysis.

中文翻译：

---

#37：危地马拉儿科国家肿瘤学联盟 (Unidad Nacional de Oncologia Pediatrica) 小儿癌症中重度 COVID-19 病例的描述

摘要

介绍

危地马拉于2020年 3 月 13^日报告了首例 SARS-CoV-2确诊病例。截至目前，已记录的确诊病例超过 140,000 例，其中 8% 的患者年龄小于 20 岁。COVID-19 对儿科癌症的影响尚不清楚，尽管儿科肿瘤学机构提出了一些初步建议，但这种新疾病仍然是这一人群的挑战。该报告的目的是描述在儿童癌症大流行的前 8 个月内在儿科国家肿瘤学联盟 (UNOP) 中发生的中重度 COVID-19 儿童癌症病例。

方法

这是一份关于 2020 年 5 月至 2020 年 5 月至 12 月在 UNOP 使用 PCR 技术通过鼻咽拭子确诊的 20 岁以下儿童癌症患者和 SARS-CoV-2 感染的描述性前瞻性报告。 对所有患者进行了 SARS-CoV-2 检测出现感染症状的人，或在不考虑症状的情况下对入住 UNOP 的患者进行筛查。收集了关于性别、年龄、主要肿瘤学诊断、确诊的合并感染和在 COVID-19 时接受的治疗的信息。如果患者需要补充氧气，则考虑为中度疾病，如果入住重症监护病房 - ICU- 继发于 COVID-19，则考虑为重度疾病。

结果

确认了 201 名患有 SARS-CoV-2 感染的儿科癌症患者。64% 为男性 (n=128)，年龄中位数为 9.5 岁（5 米至 18 岁）。主要肿瘤诊断为白血病 65% (n=129)，其他实体瘤 35% (n=72)，5% (n=10) 的患者接受姑息治疗。在白血病患者中，40% 接受诱导治疗 (n=51)，25% 巩固治疗 (n=32)，19% 维持治疗 (n=25)。32% (n=64) 最常见的初始症状是发烧，33% 无症状 (n=67)。22% 的患者发展为中度疾病 (n=44) 和 13% 的重症患者 (n=26)。在 COVID-19 期间共有 13 名患者死亡 (6%)，其中 7 名患者在接受积极治疗后死亡 (3%)。与接受强烈化疗的其他肿瘤患者相比，白血病患者发生中重度疾病的风险并不高（OR=0.7），但死亡风险可能更高（OR=1.41）。在白血病患者中，接受诱导治疗的患者发生中重度疾病的风险高于巩固治疗（OR=6.7）或维持治疗（OR=3.04）的患者。诱导治疗期间白血病患者的死亡风险似乎更高（OR=1.94）。在 COVID-19 期间，确诊的合并感染与更高的重症风险 (OR=1.95) 和死亡风险 (OR=5.2) 相关。与巩固治疗（OR=6.7）或维持治疗（OR=3.04）的患者相比，接受诱导治疗的患者发生中重度疾病的风险更高。诱导治疗期间白血病患者的死亡风险似乎更高（OR=1.94）。在 COVID-19 期间，确诊的合并感染与更高的重症风险 (OR=1.95) 和死亡风险 (OR=5.2) 相关。与巩固治疗（OR=6.7）或维持治疗（OR=3.04）的患者相比，接受诱导治疗的患者发生中重度疾病的风险更高。诱导治疗期间白血病患者的死亡风险似乎更高（OR=1.94）。在 COVID-19 期间，确诊的合并感染与更高的重症风险 (OR=1.95) 和死亡风险 (OR=5.2) 相关。

结论

COVID-19 在儿科癌症中的死亡率很低，可能与合并感染或强化化疗有关。我们报告的重要局限性是缺乏对中重度疾病（中性粒细胞减少症或其他合并症）的潜在临床状况的分析，这些因素可能会对我们的数据分析产生影响。