This evidence review was compiled by members of the CITF Secretariat with the input from experts affiliated with the CITF and does not necessarily reflect the views of all CITF members.

By Marija Djekic-Ivankovic

Previous studies have shown that children with COVID-19 generally have a milder disease course compared to adults. However, children with cancer have a higher risk of severe disease due to infection with other respiratory viruses, suggesting they may also be at higher risk for COVID-19 complications. A recent multi-national study, published in Lancet Oncology, indicated that 20% of children and adolescents with cancer who contracted SARS-CoV-2 had severe or critical COVID-19. The authors have created the Global Registry of COVID-19 in Childhood Cancer to capture relevant data.

Authors collected data from 131 institutions in 45 countries and created a large, global, hospital-based registry of pediatric oncology patients with laboratory confirmed SARS-CoV-2 called the “Global Registry of COVID-19 in Childhood Cancer” that captures demographics, oncological diagnosis, clinical course, and cancer therapy information. This registry remains open to collect data from other hospitals.

Key findings:

  • 20% of children and adolescents with cancer who contracted SARS-CoV-2 had severe or critical COVID-19.
  • Results indicate that among 1,319 children and adolescents (<19 years) with cancer and COVID-19, deaths occurred in 3.8%, which is more than four times greater than in the general pediatric population.
  • Documented health disparities across World Bank income groups highlighted that global differences in supportive care infrastructure could affect outcomes: there was a greater proportion of cases with severe or critical illness reported in low-income and lower-middle-income countries compared to higher income countries.
  • The authors were able to identify several clinical patient factors, including lymphopenia and neutropenia, which were associated with severe disease outcomes.

These data suggest that children and adolescents with cancer are at high-risk of developing severe COVID-19 illness globally and should therefore be prioritised for early access to vaccination and for other supportive care interventions when resources are limited. This is very important as results suggest that it might be prudent to delay or modify cancer therapy for patients with active COVID-19 if this is feasible, particularly in patients with other risk factors for severe disease.

Mukkada S, Bhakta N, Chantada G, Chen Y, Vedaraju Y, Faughnan L, Homsi M, Muniz-Talavera H, Ranadive R, Metzger M, Friedrich P, Agulnik A, Jeha S, Lam C, Dalvi R, Hessissen L, Moreira D, Santana V, Sullivan M, Bouffet E, Caniza M, Devidas M, Pritchard-Jones K, Rodriguez-Galindo C. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. The Lancet Oncology, doi: 10.1016/S1470-2045(21)00454-X