Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee.
JAMA Netw Open. 2024 Feb 5;7(2):e2355727. doi: 10.1001/jamanetworkopen.2023.55727.
COVID-19 in pediatric patients with acute lymphoblastic leukemia or lymphoma (ALL/LLy) has not been described in detail and may affect chemotherapy administration and long-term outcomes.
To describe the clinical presentation of COVID-19 and chemotherapy modifications in pediatric patients with ALL/LLy.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective case series of patients at St Jude Children's Research Hospital and its affiliate sites with newly diagnosed ALL/LLy who were treated on the Total XVII protocol (NCT03117751) between March 30, 2020, and June 20, 2022. Participants included patients aged 1 to 18 years who were receiving protocol chemotherapy. Acute symptoms and chemotherapy modifications were evaluated for 60 days after the COVID-19 diagnosis, and viral clearance, adverse events, and second SARS-CoV-2 infections were followed up during the 27-month study period.
SARS-CoV-2; all patients were screened at least weekly and at symptom onset and/or after known exposure to SARS-CoV-2.
Description of the spectrum of COVID-19 illness and chemotherapy modifications.
Of 308 pediatric patients, 110 (36%) developed COVID-19 at a median age of 8.2 (IQR, 5.3-14.5) years. Sixty-eight patients (62%) were male. Most patients were in the continuation/maintenance phase of chemotherapy (101 [92%]). Severe disease was rare (7 [6%]) but was associated with older age, higher white blood cell counts at ALL/LLy diagnosis, lower absolute lymphocyte counts at COVID-19 diagnosis, abnormal chest imaging findings, and SARS-CoV-2 reinfection. Rare but serious thrombotic events included pulmonary embolism and cerebral venous sinus thrombosis (n = 1 for each). No multisystem inflammatory syndrome in children or death was seen. SARS-CoV-2 reinfection occurred in 11 patients (10%) and was associated with older age and with receiving standard or high-risk vs low-risk ALL/LLy therapy. Chemotherapy interruptions occurred in 96 patients (87%) and were longer for patients with severe disease, SARS-CoV-2 reinfection, and/or a COVID-19 diagnosis during the pre-Omicron variant period vs the post-Omicron period (after December 27, 2021).
In this case series of COVID-19 in pediatric patients with ALL/LLy, severe COVID-19 was rare, but chemotherapy administration was affected in most patients. Long-term studies are needed to establish the outcomes of COVID-19 in this population.
COVID-19 在患有急性淋巴细胞白血病或淋巴瘤（ALL/LLy）的儿科患者中的描述并不详细，可能会影响化疗的实施和长期结果。
描述 COVID-19 在患有 ALL/LLy 的儿科患者中的临床表现和化疗调整。
设计、地点和参与者：这是一项回顾性病例系列研究，纳入了在圣裘德儿童研究医院及其附属机构接受新诊断的 ALL/LLy 治疗的患者，这些患者均接受了总 XVII 方案（NCT03117751）治疗，研究时间为 2020 年 3 月 30 日至 2022 年 6 月 20 日。参与者包括年龄在 1 至 18 岁之间、正在接受方案化疗的患者。在 COVID-19 诊断后 60 天内评估急性症状和化疗调整情况，并在 27 个月的研究期间跟踪病毒清除情况、不良事件和第二波 SARS-CoV-2 感染情况。
SARS-CoV-2；所有患者每周至少筛查一次，并在出现症状时或已知暴露于 SARS-CoV-2 后进行筛查。
描述 COVID-19 疾病谱和化疗调整情况。
在 308 名儿科患者中，110 名（36%）在中位年龄为 8.2（IQR，5.3-14.5）岁时确诊 COVID-19。68 名患者（62%）为男性。大多数患者处于化疗的延续/维持阶段（101 例[92%]）。严重疾病较为罕见（7 例[6%]），但与年龄较大、ALL/LLy 诊断时白细胞计数较高、COVID-19 诊断时绝对淋巴细胞计数较低、胸部影像学异常以及 SARS-CoV-2 再感染有关。罕见但严重的血栓事件包括肺栓塞和脑静脉窦血栓形成（各 1 例）。未观察到儿童多系统炎症综合征或死亡。11 名患者（10%）发生 SARS-CoV-2 再感染，与年龄较大以及接受标准或高危与低危 ALL/LLy 治疗有关。96 名患者（87%）出现化疗中断，与严重疾病、SARS-CoV-2 再感染以及/或 COVID-19 诊断在奥密克戎变异株流行前时期（2021 年 12 月 27 日之后）相比，在奥密克戎变异株流行时期（后），化疗中断时间更长。
在这项患有 ALL/LLy 的儿科 COVID-19 病例系列研究中，严重 COVID-19 较为罕见，但大多数患者的化疗实施受到影响。需要进行长期研究以确定该人群 COVID-19 的结局。
