Background : Since the beginning of SARS-CoV-2 pandemic, it has
been widely recognized that children and adolescents seem to have milder
clinical courses as compared to adult counterparts. However, there is
concern that vulnerable collectives including pediatric patients treated
for cancer or under immunosuppression may be at higher risk.
Methods : We retrospectively collected Spanish COVID-19 cases in
children and adolescents with solid and hematological malignancies,
non-malignant chronic hematologic conditions, and post allogeneic-stem
cell transplantation, from the beginning of the pandemic on January 31
to April 24, 2020.
Results : We included 47 cases with RT-PCR positive COVID-19
from 41 centers in Spain, where 97.6% of pediatric patients are treated
for cancer. In most cases (76.6%), infection was asymptomatic, or
symptoms were mild. Severe illness was observed in 14.9% of cases with
respiratory distress and/or hypoxemia, and 8.5% required admission to
the PICU. Symptomatic patients received supportive care associated with
antiviral and immunomodulatory agents depending upon severity.
Anticancer therapy was withhold in the majority of cases during the
infection course. Most patients recovered from COVID-19. Two deaths were
reported.
Conclusion : In our cohort, most children receiving anticancer
chemotherapy presented a mild clinical course and had a good outcome.
Highly immunosuppressed patients with major comorbidities were at higher
risk of severe infections. Among this fragile collective, individualized
expert discussion is critical for anti-infectious therapy and
appropriate anticancer treatment.