Case 1
14-year-old boy with T-cell acute lymphoblastic leukemia was being treated as per BFM95 protocol for standard risk disease. He was in complete remission after end of induction. In the 3rdweek of consolidation phase, he was found to be SARSCOV2 positive by PCR (run on Thermofisher TaqPath kit) performed on nasopharyngeal & throat swab (Ct values; N-32.52 ORF-32, S-34.66) on screening test prior to giving chemotherapy. He was asymptomatic and his total leukocyte count (TLC) was low 1580/mm3, Absolute neutrophil count (ANC) -140/mm3 and absolute lymphocyte count (ALC) was- 990/mm3. As he was asymptomatic so no specific treatment was given and he was isolated at home for next 2 weeks. After 2 weeks his SARSCOV2 PCR was negative. He was restarted on chemotherapy as per protocol and finished consolidation. Later he was given a course of high dose methotrexate (5 g/m2) and oral 6-mercaptopurine 25 mg/m2 daily for central nervous system prophylaxis which he tolerated well. Two weeks later he was again screened for SARSCOV2 prior to next chemotherapy and his PCR was positive (Ct values; N-19.25, ORF-18.7, S-18.02). This was 71 days after the first infection. This time his TLC was 7450/mm3 and ANC was 3500/mm3and ALC 2200/mm3. He was asymptomatic so again he was isolated at home for 2 weeks and chemotherapy was stopped. After 2 weeks we rechecked his PCR and it was still positive (Ct values; N-31.25, ORF-31.57, S-30.48) so we treated him with tablet hydroxychloroquine 200 mg orally twice daily for 5 days and retested PCR and it became negative. His IgG antibody (qualitative test by Orthoclinical diagnostic kit) against SARSCO2 was positive (1.75 cutoff value for positive >1)). He was given further chemotherapy as per protocol.