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