COVID-19 感染在唐氏综合征和血液系统恶性肿瘤的儿童、青少年和年轻成年人中。

COVID-19 infection in children, adolescents, and young adults with Down syndrome and hematologic malignancies.

机构信息

Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Department of Surgery, Boston University, Boston, USA.

出版信息

Pediatr Blood Cancer. 2024 Aug;71(8):e31082. doi: 10.1002/pbc.31082. Epub 2024 May 28.

DOI:10.1002/pbc.31082

PMID:38804869

Abstract

INTRODUCTION

Children, adolescents, and young adults (CAYAs) with Down syndrome (DS) and hematologic malignancies are particularly vulnerable to infections and related complications. There are limited data regarding COVID-19 infections in this group. We aimed to understand the clinical course of COVID-19 in this population.

METHODS

This observational study leverages the de-identified clinical and sociodemographic data captured by the Pediatric Oncology COVID-19 Case Report Registry (POCC) regarding CAYAs with cancer and COVID-19. We evaluated CAYAs (≤21 years at COVID-19 infection) with hematologic malignancies and COVID-19 reported from April 1, 2020 to May 2, 2023, comparing those with and without DS. Using multivariable logistic regression, we examined rates of hospitalization, intensive care unit (ICU) admission, respiratory support, and changes in cancer-directed therapy.

RESULTS

Among 1408 CAYAs with hematologic malignancies, 55 had DS (CAYA-DS). CAYA-DS had higher rates of hospitalization, ICU admission, and respiratory support (p < .001) than CAYAs without DS. Similarly, multivariable analyses found higher odds of hospitalization (odds ratio [OR] = 2.8, 95% confidence interval [CI]: 1.5-5.1), ICU admission (OR = 4.2, 95% CI: 1.9-9.1), and need for respiratory support (OR = 4.2, 95% CI: 2.0-8.8) among CAYA-DS. Modifications to cancer-directed therapy were more common among CAYA-DS when related to neutropenia (p = .001), but not when unrelated to neutropenia (p = .88); CAYA-DS did not have higher odds of changes to cancer-directed therapy (OR = 1.20, 95% CI: 0.7-2.1).

CONCLUSIONS

We identify CAYA-DS with hematologic malignancies as a vulnerable subpopulation at greater risk for severe COVID-19 infection. This can inform conversations with patients and families regarding therapeutic and preventive measures, as well as the risks and benefits of modifying chemotherapy in the setting of COVID-19.

摘要

引言

唐氏综合征（DS）患儿、青少年和年轻成人（CAYA）易患感染及相关并发症，血液系统恶性肿瘤患儿更是如此。关于该人群感染 COVID-19 的数据有限。我们旨在了解该人群 COVID-19 的临床病程。

方法

本观察性研究利用小儿肿瘤 COVID-19 病例报告登记处（POCC）中记录的患有癌症和 COVID-19 的 CAYA 的去识别临床和社会人口统计学数据。我们评估了 2020 年 4 月 1 日至 2023 年 5 月 2 日期间报告的患有血液系统恶性肿瘤和 COVID-19 的≤21 岁的 CAYA，比较了有 DS 和无 DS 的患者。使用多变量逻辑回归，我们检查了住院、重症监护病房（ICU）入院、呼吸支持以及癌症治疗改变的发生率。

结果

在 1408 例患有血液系统恶性肿瘤的 CAYA 中，有 55 例患有 DS（CAYA-DS）。与无 DS 的 CAYA 相比，CAYA-DS 的住院、ICU 入院和呼吸支持率更高（p<.001）。同样，多变量分析发现，CAYA-DS 住院的可能性更高（比值比[OR] = 2.8，95%置信区间[CI]：1.5-5.1）、ICU 入院的可能性更高（OR = 4.2，95% CI：1.9-9.1）和需要呼吸支持的可能性更高（OR = 4.2，95% CI：2.0-8.8）。与中性粒细胞减少无关时（p =.88），CAYA-DS 改变癌症靶向治疗的可能性更高（OR = 1.20，95% CI：0.7-2.1），但与中性粒细胞减少相关时（p =.001），改变癌症靶向治疗的可能性更高。