Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently constitutes the leading and overwhelming health issue worldwide. In comparison with adults, children present milder symptoms, with most having an asymptomatic course. We hypothesized that COVID-19 infection has a negative impact on the continuation of chemotherapy and increases nonrelapse mortality. This study was performed to assess the course of SARS-CoV-2 among children with hematological or oncological malignancies and its impact on cancer therapy. Records of SARS-CoV-2 infection in 155 children with malignancies from 14 Polish centers for pediatric hematology and oncology were collected and analyzed. SARS-CoV-2 replication was observed in 155 patients. Forty-nine patients were symptomatic, with the following being the most common manifestations: fever (31 patients), gastrointestinal symptoms (10), coryza (13), cough (13) and headache (8). In children who were retested, the median time of a positive PCR result was 16 days (range 1–70 days), but 12.7% of patients were positive beyond day + 20. The length of viral PCR positivity correlated with the absolute neutrophil count at diagnosis. Seventy-six patients did not undergo further SARS-CoV-2 testing and were considered convalescents after completion of isolation. Antibiotic therapy was administered in 15 children, remdesivir in 6, convalescent plasma in 4, oxygen therapy in 3 (1—mechanical ventilation), steroids in 2, intravenous immunoglobulins in 2, and heparin in 4. Eighty patients were treated with chemotherapy within 30 days after SARS-CoV-2 infection diagnosis or were diagnosed with SARS-CoV-2 infection during 30 days of chemotherapy administration. Respiratory symptoms associated with COVID-19 and associated with oxygen therapy were present in 4 patients in the study population, and four deaths were recorded (2 due to COVID-19 and 2 due to progressive malignancy). The probability of 100-day overall survival was 97.3% (95% CI 92.9–99%). Delay in the next chemotherapy cycle occurred in 91 of 156 cases, with a median of 14 days (range 2–105 days). For the majority of pediatric cancer patients, SARS-CoV-2 infection does not result in a severe, life-threatening course. Our data show that interruptions in therapy are common and can result in suboptimal therapy.

中文翻译：

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小儿癌症患者中的 COVID-19 与治疗中断有关，但与短期死亡率无关：波兰国家研究

由严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 引起的 2019 年冠状病毒病 (COVID-19) 目前构成了全球主要和压倒性的健康问题。与成人相比，儿童的症状较轻，大多数为无症状病程。我们假设 COVID-19 感染对继续化疗有负面影响并增加非复发死亡率。本研究旨在评估 SARS-CoV-2 在患有血液或肿瘤恶性肿瘤的儿童中的病程及其对癌症治疗的影响。收集并分析了来自波兰 14 个儿科血液学和肿瘤学中心的 155 名恶性肿瘤儿童的 SARS-CoV-2 感染记录。在 155 名患者中观察到 SARS-CoV-2 复制。49 名患者出现症状，以下是最常见的表现：发烧（31 名患者）、胃肠道症状（10）、鼻炎（13）、咳嗽（13）和头痛（8）。在重新检测的儿童中，PCR 结果阳性的中位时间为 16 天（范围 1-70 天），但 12.7% 的患者在超过 20 天后仍呈阳性。病毒 PCR 阳性的长度与绝对中性粒细胞计数相关诊断。76 名患者未接受进一步的 SARS-CoV-2 检测，并在完成隔离后被视为恢复期。15 名儿童接受了抗生素治疗，6 名接受了瑞德西韦治疗，4 名接受了恢复期血浆治疗，3 名接受了氧疗（1 名机械通气），2 名接受了类固醇治疗，2 名接受了静脉免疫球蛋白治疗，4 名接受了肝素治疗。80 名患者在 SARS-CoV-2 感染诊断后 30 天内接受了化疗，或在化疗 30 天内被诊断为 SARS-CoV-2 感染。研究人群中的 4 名患者出现与 COVID-19 和氧疗相关的呼吸系统症状，并记录了 4 例死亡（2 例死于 COVID-19，2 例死于进行性恶性肿瘤）。100 天总生存的概率为 97.3% (95% CI 92.9–99%)。156 例中有 91 例发生下一个化疗周期延迟，中位时间为 14 天（范围 2-105 天）。对于大多数儿科癌症患者来说，SARS-CoV-2 感染不会导致严重的、危及生命的病程。我们的数据表明，治疗中断很常见，可能导致治疗效果不佳。