COVID-19 in children with cancer: Severe disease and disrupted treatment

Results from the registry indicated that in addition to more severe or critical infections, pediatric cancer patients were more likely to be hospitalized and die than were other children. The pandemic also disrupted cancer treatment. These effects were observed more significantly in low- and middle-income countries, where the odds of severe or critical disease from COVID-19 were nearly 6 times higher than in high-income countries.

"The results clearly and definitively show that children with cancer fare worse with COVID-19 than children without cancer," said corresponding author Sheena Mukkada, M.D., St. Jude Departments of Global Pediatric Medicine and Infectious Diseases. "This global collaboration helps clinicians make evidence-based decisions about prevention and treatment, which, unfortunately, remain relevant as the pandemic continues."

A greater burden for childhood cancer patients

This is the first multinational study to describe the outcomes of a large cohort of children and adolescents with cancer or hematopoietic stem cell transplantation and laboratory diagnosis of COVID-19. The registry remains open and is enrolling children younger than 19 years old.

The analysis looked at 1,500 children from 131 hospitals in 45 countries from April 15, 2020, to February 1, 2021. This is prior to vaccinations becoming available to older children in some areas of the globe, as well as prior to the emergence of certain disease variants, including delta, which are responsible for the new surge and have become a major global concern.

The study found that 65% of patients were hospitalized and 17% required admission or transfer to a higher level of care. It also showed that 4% of patients died due to COVID-19 infections, compared to 0.01-0.7% mortality reported among general pediatric patients. Cancer care was also affected. Cancer therapy was modified in 56% of patients and 45% had chemotherapy withheld while their infections were treated.

"By working together to create this global registry, we have enabled hospitals around the world to rapidly share and learn how COVID-19 is affecting children with cancer," said the paper's co-author, Professor Kathy Pritchard-Jones, SIOP president. "The results are reassuring that many children can continue their cancer treatment safely, but they also highlight important clinical features that may predict a more severe clinical course and the need for greater vigilance for some patients."

A global pandemic and a global response

The registry suggests biologic factors that likely influence how children with cancer respond to COVID-19. Those include immune system function and the underlying disease. Analysis also showed that outcomes vary around the world, although the registry does not pinpoint causes. This variation may be due to a multitude of factors, including disruptions from the pandemic, access to care and resources, or delays in infection diagnosis.

Results from the registry are a call to action to address inequities in access to protective and effective treatment measures against the COVID-19 pandemic worldwide.

"Understanding a global crisis like COVID-19 requires our entire childhood cancer community around the world to come together to respond," said senior author Carlos Rodriguez-Galindo, M.D., St. Jude Global director. "The impact of this disease has been felt in every corner of the world, but particularly in low- and middle-income countries compared to high-income countries. There are critical differences based on where a child lives. This registry is a tool that is helping us understand what that means for children with cancer everywhere."

The registry (http://covid19childhoodcancer.org/) is still enrolling patients and continues to add new countries. It includes freely available data-visualization tools so that anyone, anywhere, can access the information.

Learn more about COVID-19 and vaccination

Vaccinations against COVID-19 have been demonstrated to be safe and effective in preventing severe forms of the disease, helping patients avoid hospitalizations and the need for mechanical ventilation. In the United States, vaccines are available and encouraged for children 12 years of age and older. Vaccination is one way to protect not only yourself but your community, including those who are at high risk of severe disease such as children with cancer.

Learn more about how Vaccines Bring Us Closer (https://www.stjude.org/media-resources/special-announcements/get-vaccinated.html) and check out COVID-19 resources from St. Jude (https://www.stjude.org/treatment/patient-resources/covid-19-resources-from-st-jude.html).

Authors and Funding

The study's other authors are Guillermo Chantada, Hospital San Joan de Deu Barcelona, Spain; Rashmi Dalvi, Bombay Hospital Institute of Medical Sciences Mumbai, India; Laila Hessissen, Mohammed V University Rabat, Morocco; Michael Sullivan, University of Melbourne, Australia; Eric Bouffet, Hospital for Sick Children Toronto, Canada; Nickhill Bhakta, Yichen Chen, Yuvanesh Vedaraju, Lane Faughnan, Maysam Homsi, Hilmarie Muniz-Talavera, Radhikesh Ranadive, Monika Metzger, Paola Friedrich, Asya Agulnik, Sima Jeha, Catherina Lam, Daniel Moreira, Victor Santana, Miguela Caniza and Meenakshi Devidas of St. Jude; and more than 150 members of the Global Registry of COVID-19 in Childhood Cancer.

The study was funded by the National Institutes of Health (Cancer Center Support grant CA21765), and ALSAC, the fundraising and awareness organization of St. Jude.