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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 589-590

COVID-19 in children with hematological disorders – Outcomes, impact on management, and the way forward


1 Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission11-Aug-2021
Date of Decision19-Aug-2021
Date of Acceptance19-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Nihar Desai
Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_187_21

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How to cite this article:
Desai N, Gupta A, Mehta P. COVID-19 in children with hematological disorders – Outcomes, impact on management, and the way forward. Cancer Res Stat Treat 2021;4:589-90

How to cite this URL:
Desai N, Gupta A, Mehta P. COVID-19 in children with hematological disorders – Outcomes, impact on management, and the way forward. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:589-90. Available from: https://www.crstonline.com/text.asp?2021/4/3/589/327777



We read with interest the article by Bhayana et al.[1] which reported favorable outcomes of COVID-19 in children with hematological disorders, with a majority having asymptomatic or mild disease.

This is consistent with data from the Global Registry of COVID-19 in Pediatric Cancer which reported asymptomatic infections in 42.3% of children.[2] Analyses of data from our center in Northern India during the first wave of the pandemic revealed good outcomes as well. We had 17 children (28.3%) in our cohort of 60 patients with hematological disorders who tested positive for COVID-19. Most children had acute leukemia (88.2%) and were undergoing immunosuppressive chemotherapy (86.6%); 7/17 (41.1%) patients required admission with 1/17 (5.8%) requiring intensive care unit care. There were no mortalities among the children in our cohort (unpublished data).

The major issues encountered in children during the first wave of COVID-19 were related to interruption in treatment, owing to logistic issues such as the institution of lockdown, scarcity of blood products, and delays in chemotherapy due to test positivity.[3],[4] Most childhood cancers are aggressive and treatment interruptions can be detrimental. Given the favorable outcomes of COVID-19 in children, it may seem prudent to avoid delays in the institution of chemotherapy, especially in those with asymptomatic or mild COVID-19.

The availability of safe and efficacious vaccines against COVID-19[5] has led to the vaccination of a significant percentage of the adult population in the developed world. Children have yet to be vaccinated worldwide, leaving them susceptible to the virus. Furthermore, the vaccine efficacy in children and young adults on chemotherapy may be suboptimal. Since children with malignancies need frequent hospital visits and daycare ward admissions, their risk of exposure to SARS-CoV-2 is high. It is thus imperative to maintain a high vigilance, especially in the subsequent waves of the pandemic.

Testing for COVID-19 in children poses additional challenges. In a meta-analysis of 11 studies including 3442 respiratory samples, the reported SARS-CoV-2 detection rate was only 54% for nasopharyngeal swabs and 43% for oropharyngeal swabs. The detection rate also depends upon the time from onset of symptoms with the highest detection rate reported between days 0 and 7 of symptoms.[6] The article by Bhayana et al. reported a test positivity rate of 3.3%.[1] The clinical profile of children with symptoms of COVID-19 despite a negative test has not been reported by the authors. The inclusion of such children in further studies might provide a better insight into the outcomes.

Bhayana et al. have reported a single case of multisystem inflammatory syndrome of children (MIS-C).[1] Immune-related adverse events, chemotherapeutic toxicity, sepsis, and MIS-C may have overlapping clinical features, making a diagnosis of MIS-C difficult in these children.[7] A high index of suspicion is warranted as delays in diagnosis of MIS-C may be fatal. Furthermore, children receiving immunosuppressive chemotherapy have typically significant quantitative and qualitative abnormalities in T- and B-cell function and may not mount a significant antibody response for diagnosis of a prior COVID-19 infection. It would be interesting to test the antibody responses in children with COVID-19 infection in larger cohorts. Of 22 children with COVID-19 in this study, 10% had a negative antibody response against SARS-CoV-2 on follow-up.

Although children with cancer currently have favorable outcomes from COVID-19, outcomes in the subsequent waves, especially with the emergence of variants, may not be as good. Therefore, the optimal timing of reinstitution of chemotherapy, the more sensitive tests for detection of SARS-CoV-2, the immune response to the COVID-19 vaccine and natural infection, and the emerging risk of MIS-C need further exploration in larger cohorts.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bhayana S, Kalra M, Sachdeva P, Sachdeva A. Clinical profile and outcomes of COVID-19 infection during the first wave in children with hematological illnesses and cancer: An observational study from a tertiary care center in North India. Cancer Res Stat Treat 2021;4:262-9.  Back to cited text no. 1
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2.
St. Judes Global ISoPo. COVID-19 in Pediatric Cancer Global Registry Data [updated 27 September 2020. St. Jude Global (2020). Available from: https://global.stjude.org/en-us/global-covid-19-observatory-and-resource-center-for-childhood-cancer/registry.html. [Last accessed on 2021 Aug 11].  Back to cited text no. 2
    
3.
Bansal S, Dolendo M, Hoa Nguyen TK, Sharma K. Survival of children with cancers amidst COVID-19: A fight with two enemies. Cancer Res Stat Treat 2020;3:281-3.  Back to cited text no. 3
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4.
Saroha M, Moulik NR. COPING with CORONA: A developing country perspective on managing children with cancer during COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:97-101.  Back to cited text no. 4
    
5.
Batra U, Nathany S, Bansal N, Sharma M. COVID-19 vaccination status in Indian patients with cancer: An observational study. Cancer Res Stat Treat 2021;4:219-23.  Back to cited text no. 5
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6.
Mohammadi A, Esmaeilzadeh E, Li Y, Bosch RJ, Li JZ. SARS-CoV-2 detection in different respiratory sites: A systematic review and meta-analysis. EBioMedicine 2020;59:102903.  Back to cited text no. 6
    
7.
Ragoonanan D, Khazal SJ, Mejia R, Ewing L, Durand JB, Bashoura L, et al. Case discussion and literature review: Cancer immunotherapy, severe immune-related adverse events, multi-inflammatory syndrome, and severe acute respiratory syndrome Coronavirus 2. Front Oncol 2021;11:625707.  Back to cited text no. 7
    




 

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