Discussion
Previous reports intimate that pediatric oncology patients with COVID-19 infection would not appear to be at increased risk for deleterious outcomes. Our report would suggest otherwise. Case 1 continues to have heart failure more than six months after initial infection with COVID-19 with MRI findings consistent with myocardial scarring and ischemia. In contrast, Case 2 followed a more typical clinical course of heart failure in children with MIS-C with rapid improvement after immunomodulatory treatment6,7. Finally, COVID-19 infection largely contributed to the death of Case 3.
Prior anthracycline exposure seems to correlate with a more severe COVID-19 disease course, consistent with the increased risk for cardiotoxicity seen with anthracyclines8 and the increased risk of morbidity and mortality seen in COVID-19 infected adults with concomitant cardiac disease.9,10 Similar to other reports, we did not find any correlation with immune status at time of infection or type A blood with the development of severe disease.4 We did not have sufficient data to evaluate additional risk factors such as inflammatory markers, iron overload, or post-COVID cardiac function.
This case series illustrates that pediatric oncology patients are potentially at increased risk for cardiorespiratory complications from COVID-19 infections and prior anthracycline exposure may represent a risk factor for a more severe disease course. However, given the limited sample size and lack of data of other potential risk factors, follow-up studies are merited.