Center for Cancer and Blood Disorders, Pediatric Specialists of Virginia, Fairfax, Virginia, USA.
Inova Children's Hospital, Falls Church, Virginia, USA.
Pediatr Blood Cancer. 2024 Oct;71(10):e31212. doi: 10.1002/pbc.31212. Epub 2024 Jul 22.
The COVID-19 pandemic disproportionately affected persons with underlying medical conditions. SARS-CoV-2 infection susceptibility and vaccine effectiveness in pediatric hematology-oncology patients were unknown.
From February to July 2022, anti-spike and anti-nucleocapsid Ig were assayed in 354 pediatric hematology-oncology subjects, including 53 oncology patients receiving chemotherapy (cancer), 150 patients with sickle cell disease (SCD), and 151 benign consult and long-term follow-up patients (controls). Participants completed a questionnaire.
Frequencies of COVID-19 infection, defined by positive PCR/antigen test or anti-nucleocapsid Ig, were 62% in cancer, 71% in SCD, 52% in controls, with SCD statistically different than controls (p = .001). Infection was associated with COVID-19 exposure, Hispanic/Latino or Black/African American ethnicity, multi-family dwelling, sports participation; COVID-19 booster decreased association with infection. In COVID-19-positive cancer patients, 58% had positive anti-nucleocapsid and 76% had positive anti-spike (≥10 U/mL), compared to essentially 100% seroconversion in SCD and controls (p < .0001, p = .01, respectively). Infection led to high anti-spike (≥2500 U/mL) in 12% cancer, 14% SCD, and 15% controls (p = .93). Vaccination resulted in anti-spike positivity in 90% cancer, 100% SCD, and 100% controls (p = .06), and in high anti-spike in 20% cancer, 47% SCD, and 41% controls (p = .36). Of boosted subjects, one of two cancer, 6/6 SCD, and 19/19 controls exhibited high anti-spike.
Cancer patients demonstrated similar SARS-CoV-2 infection frequency as controls, but diminished antibody response to infection and vaccination. SCD patients exhibited seroconversion indistinguishable from controls. Vaccination was associated with higher frequency of high anti-spike than infection; vaccination plus booster was most effective in eliciting high anti-spike antibody detectable beyond 90 days.
COVID-19 大流行对有基础疾病的人影响更大。SARS-CoV-2 感染易感性和儿科血液肿瘤患者的疫苗有效性尚不清楚。
2022 年 2 月至 7 月，对 354 名儿科血液肿瘤学患者进行了刺突和核衣壳 Ig 检测，其中包括 53 名接受化疗（癌症）的肿瘤患者、150 名镰状细胞病（SCD）患者和 151 名良性就诊和长期随访患者（对照组）。参与者完成了一份问卷。
以 PCR/抗原检测或核衣壳 Ig 阳性定义的 COVID-19 感染率在癌症患者中为 62%，在 SCD 患者中为 71%，在对照组中为 52%，SCD 与对照组统计学差异显著（p=0.001）。感染与 COVID-19 暴露、西班牙裔/拉丁裔或黑人和非裔美国人种族、多家庭居住、参加运动有关；COVID-19 加强针降低了与感染的关联。在 COVID-19 阳性癌症患者中，58%的患者抗核衣壳呈阳性，76%的患者抗刺突（≥10 U/mL）呈阳性，而 SCD 和对照组患者的血清转化率几乎均为 100%（p<0.0001，p=0.01）。感染导致 12%的癌症、14%的 SCD 和 15%的对照组患者出现高抗刺突（≥2500 U/mL）（p=0.93）。疫苗接种使 90%的癌症、100%的 SCD 和 100%的对照组患者出现抗刺突阳性（p=0.06），使 20%的癌症、47%的 SCD 和 41%的对照组患者出现高抗刺突（p=0.36）。在接受加强针的患者中，癌症患者中有 1 例，SCD 患者中有 6 例，对照组中有 19 例出现高抗刺突。
癌症患者的 SARS-CoV-2 感染频率与对照组相似，但对感染和疫苗接种的抗体反应减弱。SCD 患者的血清转化率与对照组无明显差异。与感染相比，疫苗接种更能引起高抗刺突的发生；疫苗接种加加强针最能有效地诱导可检测到 90 天以上的高抗刺突抗体。
