Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, California, USA.
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Int J Cancer. 2022 Dec 1;151(11):1913-1924. doi: 10.1002/ijc.34202. Epub 2022 Jul 19.
Pediatric oncology patients are at risk for poor outcomes with respiratory viral infections. Outcome data for COVID-19 in children and young adults with cancer are needed; data are sparse for obese/overweight and adolescent and young adult subgroups. We conducted a single center cohort study of COVID-19 outcomes in patients younger than 25 years with cancer. Candidate hospitalization risk factors were analyzed via univariable and multivariable analyses. Eighty-seven patients with cancer and COVID-19 were identified. Most were Hispanic/Latinx (n = 63, 72%). Forty-two (48%) were overweight/obese. Anticancer therapy included chemotherapy only (n = 64, 74%), chimeric antigen receptor T-cells (CAR-T, n = 7), hematopoietic stem cell transplantation (HSCT, n = 12), or CAR-T and HSCT (n = 4). There was no COVID-19 related mortality. Twenty-six patients (30%) required COVID-19 related hospitalization; 4 required multiple hospitalizations. Nine (10%) had severe/critical infection; 6 needed intensive care. COVID-19 resulted in anticancer therapy delays in 22 (34%) of 64 patients on active therapy (median delay = 14 days). Factors associated with hospitalization included steroids within 2 weeks prior to infection, lymphopenia, previous significant non-COVID infection, and low COVID-19 PCR cycle threshold value. CAR-T recipients with B-cell aplasia tended to have severe/critical infection (3 of 7 patients). A COVID-19 antibody response was detected in 14 of 32 patients (44%). A substantial proportion of COVID-19 infected children and young adults with cancer require inpatient management; morbidity may be high in B-cell immunodeficiency. However, a majority of patients can be taken through chemotherapy without prolonged therapy delays. Viral load is a potential outcome predictor in COVID-19 in pediatric cancer.
儿科肿瘤患者在发生呼吸道病毒感染时，其预后可能较差。需要了解儿童和青少年癌症患者 COVID-19 的预后数据；肥胖/超重和青少年及年轻成人亚组的数据则较为匮乏。我们对 25 岁以下癌症患者的 COVID-19 结局进行了单中心队列研究。通过单变量和多变量分析，对候选住院风险因素进行了分析。确定了 87 例患有癌症和 COVID-19 的患者。其中大多数为西班牙裔/拉丁裔（n=63，72%）。42 例（48%）超重/肥胖。抗癌治疗包括仅化疗（n=64，74%）、嵌合抗原受体 T 细胞（CAR-T，n=7）、造血干细胞移植（HSCT，n=12）或 CAR-T 和 HSCT（n=4）。无 COVID-19 相关死亡病例。26 例（30%）患者因 COVID-19 需住院治疗；4 例患者需多次住院治疗。9 例（10%）患者感染严重/危重症；6 例患者需要重症监护。22 例（34%）正在接受活性治疗的患者（n=64）因 COVID-19 而延迟了抗癌治疗（中位延迟时间=14 天）。与住院相关的因素包括感染前 2 周内使用类固醇、淋巴细胞减少、以前有过严重非 COVID 感染以及 COVID-19 PCR 循环阈值低。发生 B 细胞发育不全的 CAR-T 治疗患者倾向于发生严重/危重症感染（7 例患者中的 3 例）。在 32 例患者中的 14 例（44%）中检测到 COVID-19 抗体反应。相当一部分 COVID-19 感染的儿童和青少年癌症患者需要住院治疗；B 细胞免疫缺陷患者的发病率可能较高。然而，大多数患者可在不延长治疗时间的情况下完成化疗。病毒载量可能是儿科癌症 COVID-19 的一个潜在预后预测指标。
