Management and Outcome of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Centre Experience from a Developing Country

Hammad, Mahmoud; Shalaby, Lobna; Sidhom, Iman; Sherief, Nancy; Abdo, Ibrahim; Soliman, Sonia; Madeny, Youssef; Hassan, Reem; Elmeniawy, Shaimaa; Khamis, Nagwa; Zaki, Iman; Mansour, Tarek; El-Ansary, Mohamed Gamal; El-Halfawy, Ahmed; Abouelnaga, Sherif; Elhaddad, Alaa

INTRODUCTION: : Sufficient data pertaining to the impact of the Coronavirus disease-2019 (COVID-19) on pediatric cancer patients is still lacking. The aim of this prospective study was to describe clinical management and outcomes of COVID-19 in pediatric oncology patients. PATIENTS AND METHODS: : Conducted between May 1(st) and November 30, 2020, this study included 76 pediatric oncology patients with confirmed COVID-19. Remdesivir (RDV) was the antiviral therapy used. RESULTS: : The median age of patients was 9 years. Sixty patients were on first line treatment. Hematological malignancies constituted 86.8% of patients. Severe to critical infections were 35.4% of patients. The commonest symptom was fever (93.4%). Chemotherapy was delayed in 59.2% of patients and doses were modified in 30.2%. The sixty-day overall survival (OS) stood at 86.8%, with mortalities occurring only among critical patients. Of sixteen acute leukaemia patients in the first induction therapy, 13 survived and 10 achieved complete remission. A negative RT-PCR within 2 weeks and improvement of radiological findings were statistically related to disease severity (p=0.008 and 0.002, respectively). Better OS was associated with regression of radiological findings after 30 days from infection (p=0.002). Forty-five patients received RDV, 42.1% had severe and critical forms of infection compared to 25.7% in the No-RDV group and yet OS was comparable in both groups. CONCLUSION: : Most paediatric cancer patients with COVID-19 should have good clinical outcomes except for patients with critical infections. Cancer patients can tolerate chemotherapy including induction phase, alongside COVID-19 treatment. In severe and critical COVID-19, RDV might have a potential benefit.