SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients

Gabrielle M Haeusler; Roland A Ammann; Fabianne Carlesse; Andreas H Groll; Dina Averbuch; Elio Castagnola; Philipp K A Agyeman; Bob Phillips; Flávio Gilli; Galina Solopova; Andishe Attarbaschi; Oliver Wegehaupt; Carsten Speckmann; Lillian Sung; Thomas Lehrnbecher

doi:10.1016/j.ejca.2021.09.027

SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients

Gabrielle M Haeusler, Roland A Ammann, Fabianne Carlesse, Andreas H Groll, Dina Averbuch, Elio Castagnola, Philipp K A Agyeman, Bob Phillips, Flávio Gilli, Galina Solopova, Andishe Attarbaschi, Oliver Wegehaupt, Carsten Speckmann, Lillian Sung, Thomas Lehrnbecher

Research output: Contribution to journal › Article › peer-review

Abstract

PURPOSE: There are limited data on SARS-CoV-2 (COVID-19) infection in children with cancer or after haematopoietic stem cell transplant (HSCT). We describe the severity and outcomes of SARS-COV-2 in these patients and identify factors associated with severe disease.

METHODS: This was a multinational, observational study of children (aged <19 years) with cancer or HSCT and SARS-CoV-2 confirmed by polymerase chain reaction. COVID-19 was classified as asymptomatic, mild, moderate, severe or critical (≥1 organ support). Exact polytomous regression was used to determine the relationship between clinical variables and disease severity.

RESULTS: One hundred and thirty-one patients with COVID-19 across 10 countries were identified (median age 8 years). Seventy-eight (60%) had leukaemia/lymphoma, 48 (37%) had solid tumour and five had primary immunodeficiency and HSCT. Fever (71%), cough (47%) and coryza (29%) were the most frequent symptoms. The median duration of detectable virus was 16 days (range, 1-79 days). Forty-nine patients (37%) were hospitalised for COVID-19 symptoms, and 15 (11%) required intensive care unit-level care. Chemotherapy was delayed/modified in 35% of patients. COVID-19 was asymptomatic in 32% of patients, mild in 47%, moderate in 8%, severe in 4% and critical in 9%. In 124 patients (95%), a full recovery was documented, and four (3%) died due to COVID-19. Any comorbidity (odds ratio, 2.94; 95% confidence interval [CI], 1.81-5.21), any coinfection (1.74; 95% CI 1.03-3.03) and severe baseline neutropenia (1.82; 95% CI 1.13-3.09) were independently and significantly associated with increasing disease severity.

CONCLUSION: Although most children with cancer had asymptomatic/mild disease, 13% had severe COVID-19 and 3% died. Comorbidity, coinfection and neutropenia may increase the risk of severe disease. Our data may help management decisions in this vulnerable population.

Original language	English
Pages (from-to)	78-86
Number of pages	9
Journal	European journal of cancer (Oxford, England : 1990)
Volume	159
Early online date	9 Oct 2021
DOIs	https://doi.org/10.1016/j.ejca.2021.09.027
Publication status	E-pub ahead of print - 9 Oct 2021

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Haeusler, G. M., Ammann, R. A., Carlesse, F., Groll, A. H., Averbuch, D., Castagnola, E., Agyeman, P. K. A., Phillips, B., Gilli, F., Solopova, G., Attarbaschi, A., Wegehaupt, O., Speckmann, C., Sung, L., & Lehrnbecher, T. (2021). SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients. European journal of cancer (Oxford, England : 1990), 159, 78-86. Advance online publication. https://doi.org/10.1016/j.ejca.2021.09.027

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abstract = "PURPOSE: There are limited data on SARS-CoV-2 (COVID-19) infection in children with cancer or after haematopoietic stem cell transplant (HSCT). We describe the severity and outcomes of SARS-COV-2 in these patients and identify factors associated with severe disease.METHODS: This was a multinational, observational study of children (aged <19 years) with cancer or HSCT and SARS-CoV-2 confirmed by polymerase chain reaction. COVID-19 was classified as asymptomatic, mild, moderate, severe or critical (≥1 organ support). Exact polytomous regression was used to determine the relationship between clinical variables and disease severity.RESULTS: One hundred and thirty-one patients with COVID-19 across 10 countries were identified (median age 8 years). Seventy-eight (60%) had leukaemia/lymphoma, 48 (37%) had solid tumour and five had primary immunodeficiency and HSCT. Fever (71%), cough (47%) and coryza (29%) were the most frequent symptoms. The median duration of detectable virus was 16 days (range, 1-79 days). Forty-nine patients (37%) were hospitalised for COVID-19 symptoms, and 15 (11%) required intensive care unit-level care. Chemotherapy was delayed/modified in 35% of patients. COVID-19 was asymptomatic in 32% of patients, mild in 47%, moderate in 8%, severe in 4% and critical in 9%. In 124 patients (95%), a full recovery was documented, and four (3%) died due to COVID-19. Any comorbidity (odds ratio, 2.94; 95% confidence interval [CI], 1.81-5.21), any coinfection (1.74; 95% CI 1.03-3.03) and severe baseline neutropenia (1.82; 95% CI 1.13-3.09) were independently and significantly associated with increasing disease severity.CONCLUSION: Although most children with cancer had asymptomatic/mild disease, 13% had severe COVID-19 and 3% died. Comorbidity, coinfection and neutropenia may increase the risk of severe disease. Our data may help management decisions in this vulnerable population.",

author = "Haeusler, {Gabrielle M} and Ammann, {Roland A} and Fabianne Carlesse and Groll, {Andreas H} and Dina Averbuch and Elio Castagnola and Agyeman, {Philipp K A} and Bob Phillips and Fl{\'a}vio Gilli and Galina Solopova and Andishe Attarbaschi and Oliver Wegehaupt and Carsten Speckmann and Lillian Sung and Thomas Lehrnbecher",

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Haeusler, GM, Ammann, RA, Carlesse, F, Groll, AH, Averbuch, D, Castagnola, E, Agyeman, PKA, Phillips, B, Gilli, F, Solopova, G, Attarbaschi, A, Wegehaupt, O, Speckmann, C, Sung, L & Lehrnbecher, T 2021, 'SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients', European journal of cancer (Oxford, England : 1990), vol. 159, pp. 78-86. https://doi.org/10.1016/j.ejca.2021.09.027

TY - JOUR

T1 - SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant

T2 - An analysis of 131 patients

AU - Haeusler, Gabrielle M

AU - Ammann, Roland A

AU - Carlesse, Fabianne

AU - Groll, Andreas H

AU - Averbuch, Dina

AU - Castagnola, Elio

AU - Agyeman, Philipp K A

AU - Phillips, Bob

AU - Gilli, Flávio

AU - Solopova, Galina

AU - Attarbaschi, Andishe

AU - Wegehaupt, Oliver

AU - Speckmann, Carsten

AU - Sung, Lillian

AU - Lehrnbecher, Thomas

PY - 2021/10/9

Y1 - 2021/10/9

N2 - PURPOSE: There are limited data on SARS-CoV-2 (COVID-19) infection in children with cancer or after haematopoietic stem cell transplant (HSCT). We describe the severity and outcomes of SARS-COV-2 in these patients and identify factors associated with severe disease.METHODS: This was a multinational, observational study of children (aged <19 years) with cancer or HSCT and SARS-CoV-2 confirmed by polymerase chain reaction. COVID-19 was classified as asymptomatic, mild, moderate, severe or critical (≥1 organ support). Exact polytomous regression was used to determine the relationship between clinical variables and disease severity.RESULTS: One hundred and thirty-one patients with COVID-19 across 10 countries were identified (median age 8 years). Seventy-eight (60%) had leukaemia/lymphoma, 48 (37%) had solid tumour and five had primary immunodeficiency and HSCT. Fever (71%), cough (47%) and coryza (29%) were the most frequent symptoms. The median duration of detectable virus was 16 days (range, 1-79 days). Forty-nine patients (37%) were hospitalised for COVID-19 symptoms, and 15 (11%) required intensive care unit-level care. Chemotherapy was delayed/modified in 35% of patients. COVID-19 was asymptomatic in 32% of patients, mild in 47%, moderate in 8%, severe in 4% and critical in 9%. In 124 patients (95%), a full recovery was documented, and four (3%) died due to COVID-19. Any comorbidity (odds ratio, 2.94; 95% confidence interval [CI], 1.81-5.21), any coinfection (1.74; 95% CI 1.03-3.03) and severe baseline neutropenia (1.82; 95% CI 1.13-3.09) were independently and significantly associated with increasing disease severity.CONCLUSION: Although most children with cancer had asymptomatic/mild disease, 13% had severe COVID-19 and 3% died. Comorbidity, coinfection and neutropenia may increase the risk of severe disease. Our data may help management decisions in this vulnerable population.

AB - PURPOSE: There are limited data on SARS-CoV-2 (COVID-19) infection in children with cancer or after haematopoietic stem cell transplant (HSCT). We describe the severity and outcomes of SARS-COV-2 in these patients and identify factors associated with severe disease.METHODS: This was a multinational, observational study of children (aged <19 years) with cancer or HSCT and SARS-CoV-2 confirmed by polymerase chain reaction. COVID-19 was classified as asymptomatic, mild, moderate, severe or critical (≥1 organ support). Exact polytomous regression was used to determine the relationship between clinical variables and disease severity.RESULTS: One hundred and thirty-one patients with COVID-19 across 10 countries were identified (median age 8 years). Seventy-eight (60%) had leukaemia/lymphoma, 48 (37%) had solid tumour and five had primary immunodeficiency and HSCT. Fever (71%), cough (47%) and coryza (29%) were the most frequent symptoms. The median duration of detectable virus was 16 days (range, 1-79 days). Forty-nine patients (37%) were hospitalised for COVID-19 symptoms, and 15 (11%) required intensive care unit-level care. Chemotherapy was delayed/modified in 35% of patients. COVID-19 was asymptomatic in 32% of patients, mild in 47%, moderate in 8%, severe in 4% and critical in 9%. In 124 patients (95%), a full recovery was documented, and four (3%) died due to COVID-19. Any comorbidity (odds ratio, 2.94; 95% confidence interval [CI], 1.81-5.21), any coinfection (1.74; 95% CI 1.03-3.03) and severe baseline neutropenia (1.82; 95% CI 1.13-3.09) were independently and significantly associated with increasing disease severity.CONCLUSION: Although most children with cancer had asymptomatic/mild disease, 13% had severe COVID-19 and 3% died. Comorbidity, coinfection and neutropenia may increase the risk of severe disease. Our data may help management decisions in this vulnerable population.

U2 - 10.1016/j.ejca.2021.09.027

DO - 10.1016/j.ejca.2021.09.027

M3 - Article

C2 - 34736044

SN - 1879-0852

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SP - 78

EP - 86

JO - European journal of cancer (Oxford, England : 1990)

JF - European journal of cancer (Oxford, England : 1990)

ER -