Background
In December 2019, the new coronavirus SARS-CoV-2 outbreak started in
Wuhan, China and rapidly progressed into a pandemic1.
Europe was its next stop and Spain (first case reported on January 31,
2020) was one of the first countries registering alarming increasing
numbers of both confirmed cases and deaths. As of April 24, 2020, while
our health care system was struggling to expand fully, mostly with adult
wards and intensive care unit (ICU) beds, 202 990 cases had been tested
positive and 22 524 deaths were reported in the country due to COVID-19.
As widely reported, the clinical presentation of COVID-19 is
heterogeneous, ranging from asymptomatic or pauci-symptomatic cases to
severe forms, with an overall small percentage of patients developing
respiratory insufficiency and requiring admission in the ICU. The severe
forms were observed more frequently in male adults older than 65 years
with certain comorbidities like diabetes, hypertension, cardiac and
pulmonary conditions, and obesity2. In contrast, a
number of reported series show that pediatric patients rarely develop
critical illness3,4. The reasons underlying this
significant disparity in clinical presentation and outcome is still a
matter of debate. In Spain, from all SARS-CoV-2 confirmed positive
cases, the pediatric population (cases under the age of 19) represented
only 0.9%. Furthermore, only 2.8% of these cases required pediatric
intensive care unit (PICU) admission with a mortality rate of around
0.3%5. Children diagnosed with cancer receiving
immunosuppressive chemotherapy and cellular therapies have typically
significant abnormalities in immune function. Additionally, these
abnormalities may persist for months or years and puts them at a higher
risk for opportunistic viral –among other - infections. To this
date, reports describing the clinical and epidemiological
characteristics as well as outcomes in pediatric patients with cancer
and/or under immunosuppression secondary to allogeneic-stem cell
transplantation, or CART cell therapy acquiring the COVID-19 are scarce.
A flash survey performed on March 16, 2020 on SARS secondary to
SARS-CoV-2 infections in pediatric patients with anticancer treatment
was recently published, identifying only 9 patients (among 10,000
patients at risk) from several countries in Europe who presented a mild
or asymptomatic course6. Understandably, a reasonable
fear exists that SARS-CoV-2, like other
coronaviruses7, could cause more severe infections in
immunocompromised children, as has been observed in
adults8, especially in patients with hematological
cancer were the highest severity index and death rate have been
published9.
In this report, we present the initial Spanish experience with COVID-19
in pediatric patients affected with cancer, hematologic conditions, and
post allogeneic stem cell transplantation since the beginning of this
pandemic.