Impact of COVID-19 on Survival and Relapse in Pediatric Cancer ‎Patients

Abstract

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) significantly affects vulnerable populations, including pediatric patients with malignancies. Objectives: This study aimed to address knowledge gaps regarding COVID-19 in pediatric oncology patients by investigating clinical outcomes, complications, and risk factors. Methods: In this retrospective cohort study, data from 9,171 hospitalized pediatric patients, including 146 COVID-19-positive patients, were analyzed. Clinical, demographic, and radiological data were collected, and statistical analyses were conducted using STATA version 17. Results: During five national peaks, 9,171 pediatric patients were admitted to our tertiary oncology teaching hospital. Of these, 1,944 patients were tested for SARS-CoV-2 infection using polymerase chain reaction (PCR) assays, with 146 patients (7.5%) testing positive. Acute lymphoblastic leukemia (ALL) was the most prevalent malignancy (41%) in this study. The common presenting symptoms included fever (48%), generalized weakness (15%), and cough (15%). Radiological evaluation revealed no abnormalities in 38.58% of chest radiographs and 42.86% of computed tomography (CT) scans, whereas severe findings were noted in 11.02% and 7.14%, respectively. In this study, only 0.7% of COVID-positive patients required intensive care unit (ICU) admission, and 1.54% required mechanical ventilation. Among the COVID-positive patients, 22 (15%) died, with over 30% of these deaths occurring 10 days post-diagnosis, as indicated by the Kaplan-Meier survival estimate. Additionally, seven COVID-19-positive patients had a relapse of malignancy within 16 weeks of their COVID-19 diagnosis. The average time to relapse following SARS-CoV-2 infection was estimated to be 245.85 ± 213.24 days. Disease relapse [adjusted odds ratio (aOR): 2.09, P = 0.026], age < 12 months (aOR: 2.62, P = 0.010), and neuroblastoma diagnosis (aOR: 3.38, P = 0.005) were significantly associated with increased mortality in the multivariate analysis. Conclusions: Although a 15% mortality rate was observed among pediatric oncology patients with COVID-19, multivariate analysis did not demonstrate a statistically significant association between COVID-19 infection and an increased risk of relapse or mortality after adjusting for confounding factors. These findings suggest that, despite the observed mortality, COVID-19 infection was not an independent predictor of adverse outcomes in this population.