Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany.
Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany.
Eur J Pediatr. 2022 Apr;181(4):1413-1427. doi: 10.1007/s00431-021-04338-y. Epub 2022 Jan 10.
The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan challenges pediatric oncologists in an unexpected way. We provide a comprehensive overview, which systematically summarizes and grades evidence (QoE) on SARS-CoV-2 infections in pediatric cancer patients at 1.5 years of pandemic. A systematic literature search in PubMed combined with an additional exploratory literature review in other international databases was conducted to identify studies on children (aged < 18 years) with a malignant disease and COVID-19 infections. In total, 45 reports on 1003 pediatric cancer patients with SARS-CoV-2 infections were identified out of 1397 reports analyzed. The clinical course of COVID-19 was reported mild or moderate in 358 patients (41.7%), whereas 11.1% of patients showed severe COVID-19. In 12.7% of patients, chemotherapy was postponed, whereas 19% of patients with different underlying malignancies received chemotherapy during SARS-CoV-2 infection. Twenty-five patients with SARS-CoV-2 infections died, potentially related to COVID-19.
Despite a favorable COVID-19 outcome in most pediatric cancer patients, the morbidity is reported higher than in children without comorbidities. However, no severe COVID-19 complications were associated to the continuation of chemotherapy in some cohort studies and reports on two patients. Therefore, the risk of cancer progress or relapse due to interruption of chemotherapy has carefully to be weighed against the risk of severe COVID-19 disease with potentially fatal outcome.
• Most of pediatric patients with malignant diseases show an asymptomatic, mild or moderate clinical course of SARS-CoV-2 infection. • Current need for a basis for decision-making, whether to stop or interrupt cancer treatment in a patient infected with SARS-CoV-2, and when to continue chemotherapy.
• Review results comprising over 1000 pediatric COVID-19 cancer patients confirm mild courses of SARS-CoV-2 infection in most patients but also show the attributable mortality is at least 10 times higher compared to reports on hospitalized children without comorbidities. • Review identifies that chemotherapy was continued despite SARS-CoV-2 positivity in 18% of patients with individual chemotherapy modification according to the clinical course of SARS-CoV-2 infection and existing comorbidities. On this basis, no severe COVID-19 complications were associated to the continuation of chemotherapy in several cohort studies and two case reports.
描述 2019 年 12 月新型严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）在武汉爆发，以意想不到的方式给儿科肿瘤学家带来挑战。我们提供了一个全面的综述，系统地总结和评估了 SARS-CoV-2 感染儿科癌症患者的证据质量（QoE），该综述涵盖了大流行 1.5 年内的 SARS-CoV-2 感染。在 PubMed 中进行了系统的文献检索，并在其他国际数据库中进行了额外的探索性文献综述，以确定有关患有恶性疾病和 COVID-19 感染的儿童（年龄<18 岁）的研究。在分析的 1397 份报告中，共确定了 45 份关于 1003 名患有 SARS-CoV-2 感染的儿科癌症患者的报告。COVID-19 的临床过程在 358 名患者（41.7%）中报告为轻度或中度，而 11.1%的患者出现严重 COVID-19。在 12.7%的患者中，化疗被推迟，而在不同基础恶性肿瘤的 19%的患者在 SARS-CoV-2 感染期间接受了化疗。25 名 SARS-CoV-2 感染患者死亡，可能与 COVID-19 有关。
尽管大多数儿科癌症患者 COVID-19 结局良好，但发病率高于无合并症的儿童。然而，一些队列研究和两份患者报告表明，在某些情况下，继续化疗与严重 COVID-19 并发症无关。因此，因中断化疗而导致癌症进展或复发的风险必须与因潜在致命结局而导致的严重 COVID-19 疾病的风险仔细权衡。
大多数患有恶性疾病的儿科患者表现为无症状、轻度或中度 SARS-CoV-2 感染临床过程。目前需要决策基础，即是否停止或中断 SARS-CoV-2 感染患者的癌症治疗，以及何时继续化疗。
本次综述包括 1000 多名儿科 COVID-19 癌症患者的结果，证实大多数患者的 SARS-CoV-2 感染呈轻度过程，但也表明归因死亡率至少比报告的住院儿童无合并症高 10 倍。本次综述确定，在 18%的患者中，尽管 SARS-CoV-2 呈阳性，但仍继续化疗，并根据 SARS-CoV-2 感染和现有合并症的临床过程进行了个体化化疗修改。在此基础上，在几个队列研究和两份病例报告中，继续化疗与严重 COVID-19 并发症无关。
