RESULTS
A total sixty three childhood cancer patients were tested for SARS-CoV2
between July 2020 till September 2020. All cancer patients had undergone
active chemotherapy. Only symptomatic patients and patients due for
hospitalization for chemotherapy were screened for SARS-CoV2 infection
at our institute due to limited resources during the specific time
period
Nineteen out of sixty three (30%) cancer patients in children were
found to be positive for SARS-CoV2 by RT-PCR testing. Among COVID-19
positive patients, the median age was eight years whereas COVID-19
negative patients, the median age was five years. In COVID-19 positive
patients, sixteen (84%) were admitted and treated at hospital whereas
three patients were treated in home isolation under the supervision of
local health authority with support from our pediatric oncology expert.
Among COVID1-9 positive group, Twelve (63.2%) were male and seven
(36.8%) were female whereas in COVID-19 negative group thirty one
(70.4%) were male and thirteen (29.6%) were female (p=0.7724). In
COVID-19 positive group, Fourteen (73.6 %) were suffering from
hematological malignancy and Five have (26.4%) solid malignancy but in
COVID-19 negative group, twenty seven have hematological malignancy and
seventeen have solid malignancy (p=0.5654). There were no statistically
significant association observed with gender, cancer type, total WBC
count and absolute neutrophil count (Table1). In COVID-19 positive
group, Among the hematological malignancies; acute lymphoblastic
leukemia (ALL) comprises 57%, acute myeloid leukemia (AML) 21.5% and
non-hodgkins lymphoma accounting for 21.5% (Table1).
Survival outcome between COVID-19 positive and negative group has also
shown statistically significant association (p=0.0065). Statistically
significant association was observed between COVID-19 positivity and
patients being symptomatic (p=0.0001) (Table1).
Among COVID-19 positive patients, fourteen had fever as presenting
symptom. Cough and sore throat were seen in four patients, two patients
experienced headache. Sudden onset of breathlessness, vomiting and
diarrhea were observed in one patient each. Five patients were
asymptomatic of which four were screened before admission and one
patient was tested in view of close contact with the COVID positive
cancer child. In COVID-19 negative patients, thirty six patients were
asymptomatic and eight patients were symptomatic where fever was most
common symptom followed by cough, sore throat, diarrhea, headache.
Three patients had preexisting signs of infection and were started on
antibiotics prior to covid 19 infection. They were continued on
antibiotics during the course of covid 19 hospitalization. Demographics
and clinical characteristics have been detailed in TABLE 1.
Routine blood count done in our covid-19 positive patients showed three
patients with white blood cell (WBC) and absolute neutrophil count (ANC)
less than 1500 and 500 per microliter respectively. Two patients had ANC
20 per microliter and both of these patients had platelet less than
10,000. They also had multiple fever spikes and were on first induction
of acute myeloid leukemia (AML) receiving chemotherapy with daunorubicin
and cytosine arabinoside on day 10 and 14 respectively. Both of them
required oxygenation supplement and ultimately succumbed to death (TABLE
1).
COVID-19 Treatment:
Majority of COVID-19 positive patients received azithromycin,
dexamethasone, vitamin C, vitamin D and B complex, steroids etc. as per
institutional and prevailing national & international consensus
guidelines for childhood cancer patients. Few COVID-19 positive patients
with AML and ALL on induction chemotherapy were started on systemic
antibiotics along with anti-fungal according to the protocol in
suspicion of systemic infection and prophylactically in view of fever
spike (TABLE 2).
Four patients out of 19 expired of which three patients experienced
death during treatment for COVID 19. One patient expired after he had
been cured of COVID 19 due to complication of chemotherapy. Out of the
three expired patients two were suffering from AML and both were on
induction daunorubicin and cytosine arabinoside chemotherapy and
developed multiple systemic bacterial infection along with other
comorbidities. One osteosarcoma patient on week 3 MAP protocol (high
dose methotrexate, doxorubicin and cisplatin) tested positive for
covid-19 and was started on antivirals, antibiotics and supplement
oxygen. This patient developed sudden onset of breathlessness and
patient needed urgent ventilator support and succumbed to death. One
patient suffering from ALL on induction chemotherapy expired after
patient has been cured from covid-19 and induction chemotherapy had been
restarted. Patient expired due to systemic bacterial infection and not
due to covid-19