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.