RISK FACTORS PREDICTIVE OF CLINICAL COURSE IN PEDIATRIC CANCER PATIENTS WITH SIMULTANEOUS SARS-COV-2 INFECTION

Abstract

The clinical course of actively treated pediatric cancer patients, who are simultaneously diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been thought to be more severe than experienced by the general pediatric population; however, risk factors predictive of clinical severity in this population have not been elucidated. We describe the clinical course, risk factors affecting clinical severity, and management of coronavirus disease 2019 (COVID-19) infection at a single institution. Patients that were diagnosed with SARS-CoV-2 between January 2020 and June 2021 while actively receiving cancer treatment, excluding transplant therapies, were retrospectively reviewed. Data collected included age of SARS-CoV-2 diagnosis, cancer diagnosis, gender, race and ethnicity, age-and-gender-adjusted body mass index at time of the SARS-CoV-2 diagnosis, clinical course and severity, symptomatology, and clinical outcome. Active cancer therapies and COVID-19 specific management given during course of infection were recorded. Of the 33 patients that met inclusion criteria, 14 (42.4%) were asymptomatic during infection course while 19 (57.6%) experienced symptoms, including MIS-C (9.1%). A majority (23 patients, 69.7%) required no institutional support; 10 (30.3%) required hospitalization, of which 80.0% required oxygen, 30.0% required intensive care, and 10.0% required intubation. Eighteen (54.5%) patients had at least 1 pre-existing comorbidity, with obesity as the most common. Obesity increased the odds of hospitalization by 25.5 times (OR=25.5; p=0.002) and oxygenation requirements by 14.88 times (OR=14.88; p=0.012). Modifications to treatment included 22 (66.7%) patients that experienced delay in cancer care and 10 (30.3%) that received COVID-19 directed therapy. Hospitalization and MIS-C rates for our cohort were significantly higher than that found in the general, healthy pediatric population; mortality rates and predominance of asymptomatic to mild symptoms were consistent with the general pediatric population. Obesity was the only risk factor predictive of clinical severity and complications. Unlike in adults, ethno-race, particular cancer diagnosis, cancer therapy, and lymphopenia presentation at time of diagnosis were not significant predictive risk factors.