Children with COVID-19 have milder disease with better outcomes as compared to adults. Whilst adults especially with hematological malignancies have a more severe illness with high mortality, data on children with cancer is still evolving. We aim to describe the clinical profile and outcome of pediatric oncology patients with COVID-19 infection over the last 14 months. Fifty out of 252 patients on active treatment in the unit had documented COVID-19 infection. Severe disease was seen in 4% cases with one mortality. Children with cancer appear to be at higher risk of severe disease as compared to general pediatric population.

Background The COVID-19 pandemic had led the Indian government to announce a nationwide lockdown on the 23rd of March 2020. This study (InPOG-ACC-20-04) aimed to explore the impact of this on the accessibility of care of children with cancer in India and to see strategies adopted by hospitals for service delivery during the lockdown. Procedure Weekly average childhood cancer (<18 years) patient registrations during pre-lockdown period (Jan 1st, 2020 to March 23rd 2020) were compared with the post-lockdown period (Mar 24th, 2020 to May 31st, 2020). The effect on the scheduled treatment was investigated for the post-lockdown period. A survey of health care providers was conducted to determine centres’ strategies to deal with the effect of COVID-19. Results In 30 centres participating in this study, 1146 childhood cancer patients were registered from Jan 1st, 2020 to May 31st 2020. The weekly average patient registration was 67.3 pre-lockdown and 35.5 post-lockdown which was a decline of 47.3% with travel distance being a factor. While most centres experience this decline, there were a few who saw an increase in patient registrations. Of those patients scheduled for treatment during the post-lockdown period, 36.1% experience delays in one or more modalities. Centres adopted several strategies to including modifications to treatment protocols, increased use of growth factors, and increased support from social organisations. Conclusion Our multicentre study from India suggests that the COVID19 pandemic and the lockdown impacted two out of three children with cancer. The effect of this on survival remains to be established.

Introduction: The InPOG-HL-15-01, a multi-centric prospective study used a risk-stratified and response-based approach with a doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) backbone to treat children with newly diagnosed Hodgkin Lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after 2 cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast enhanced computed tomography (CECT) vs PET-CT on treatment decisions and outcomes. Methodology: 396 patients were enrolled and 382 had an ERA at the assigned time point. Results: At ERA, satisfactory response was documented in 277/382 (72.5%) participants and this was significantly higher in PET-CT (151/186, 81.2%) as compared to CECT (126/196, 64.3%) respectively (p value<0.001). Amongst the 203 patients with non-bulky disease (wherein the indication for RT was entirely dependent on ERA), 96/114 (84.2%) and 61/89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value=0.008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year overall survival (OS) of both groups- ERA based on CECT (91.8%) vs PET-CT (94.1%) was comparable (p value=0.391) and so was the 5 year event free survival (EFS) (86.7 vs 85.5%, p value=0.724). Conclusion: Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared to CECT and thereby decreases the need for RT in response-based treatment algorithm for HL afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.