Abstract

Children with underlying cancer are often immunocompromised. Data on severity of coronavirus disease 2019 (COVID-19) in children with cancer and its outcomes is emerging. Treatment protocols of specific cancers are decided based on the infrastructure, availability of supportive-care, and logistic issues of the locality. The purpose of the study was clinical analysis of COVID-19 in children and adolescents with cancer. The retrospective observational study was conducted at a tertiary healthcare-center in East India. Children and adolescents (aged 0–19 years) with cancer and under treatment with reverse-transcriptase-polymerase-chain-reaction (RT-PCR) confirmed COVID-19 between 5-July-2020 and 5-December-2020 were studied. Median age of the 68 identified patients was six years. Acute leukemia was the most common (66%) diagnosis. COVID-19 was asymptomatic/mildly symptomatic in 91% and moderate to severe in only 9% of patients. Fever (87%) was the commonest symptom, followed-by cough/coryza (75%). Three patients with acute myeloid leukemia (AML) and severe/critical COVID-19 and associated neutropenic sepsis were required transfer to the intensive-care-unit (ICU) for management. Three (4.4%) patients succumbed with COVID-19. Delay in treatment was observed in 63.2% of patients, and the median duration of delay was 28 days after acquiring COVID-19. Median time to attain negative COVID-19 RT-PCR was 16 days, and eight patients were repeat positives. While pediatric and adolescent cancer patients on active treatment may have a higher risk of mortality from severe COVID-19 than their healthy counterparts, the risk may be much lower than deemed. It is essential to continue cancer therapy in these children. Delay in treatment remains a concern.

摘要

患有潜在癌症的儿童通常免疫功能低下。有关癌症儿童 2019 年冠状病毒病 (COVID-19) 的严重程度及其结果的数据正在出现。特定癌症的治疗方案是根据当地的基础设施、支持性护理的可用性和后勤问题决定的。该研究的目的是对患有癌症的儿童和青少年的 COVID-19 进行临床分析。这项回顾性观察研究是在东印度的一家三级医疗保健中心进行的。研究了 2020 年 7 月 5 日至 2020 年 12 月 5 日期间患有癌症并正在接受逆转录酶聚合酶链反应 (RT-PCR) 治疗的儿童和青少年（0-19 岁）证实的 COVID-19。确定的 68 名患者的中位年龄为 6 岁。急性白血病是最常见的（66%）诊断。COVID-19 在 91% 的患者中无症状/轻度症状，仅在 9% 的患者中为中度至重度。发烧（87%）是最常见的症状，其次是咳嗽/鼻炎（75%）。三名患有急性髓性白血病 (AML) 和严重/危重 COVID-19 和相关中性粒细胞减少性脓毒症的患者需要转移到重症监护病房 (ICU) 进行管理。三名 (4.4%) 患者死于 COVID-19。在 63.2% 的患者中观察到治疗延迟，中位延迟持续时间为感染 COVID-19 后 28 天。达到阴性 COVID-19 RT-PCR 的中位时间为 16 天，8 名患者为重复阳性。虽然接受积极治疗的儿科和青少年癌症患者死于重症 COVID-19 的风险可能高于健康患者，但风险可能远低于预期。必须继续对这些儿童进行癌症治疗。治疗延误仍然是一个问题。