DISCUSSION
In our study, death among COVID-19 positive patients was (4/19) 21.0 %
but in COVID-19 negative cancer patients we had not observed any death
during the study period. In pooled meta-analysis of 3377 hematological
malignancy patients of Asia, Europe and North Americans which also
included five studies with 102 childhood hematological malignancy
patients, pooled risk of death for childhood hematological malignancy
was computed at 4% (95% CI)12 . Hamdy et al. (2021)
in 24 febrile neutropenia pediatric hematology patients seven were found
positive for COVID-19 among them three (43%) had
died13. Childhood cancer status, early SARS-COV2
infection detection, treatment protocol, resource settings, geographical
region may have impact on the varying degree of survival outcome in
COVID-19 positive childhood cancer patients.
In our study, the COVID-19 positivity among childhood cancer patients
tested for SARS COV2 was found to be approximately 30%. Fourteen
COVID-19 positive patients become negative in RT PCR testing by
11th day. Only two patients turn negative after more
than 16 days. In New York city up to 20% COVID-19 positivity was
reported in cancer patients in children5. In Madrid
region COVID-19 positivity in cancer patients in children was found to
be 1.3% only14. Pediatric cancer patients studies
related to COVID-19 very limited compared to adult cancer patients
studies. Our study was performed in cancer patients in children during
the peak period of COVID-19 infection across India therefore the outcome
of our study may be reflection of North-East region scenario.
In our study we found that COVID-19 positivity (73.6%; 14/19) was
significantly high in cancer patients with suspected covid-19 symptoms
compared to asymptomatic patients (26.4%; 5/19). There has been studies
which concluded that pediatric cancer patients may have mild or
asymptomatic COVID-19 infection8,9.
The current rapid global spread of COVID-19 infection prioritizes our
intense efforts to identify effective preventive strategies and develop
optimal medical management. There is relatively ample information
available for adult covid-19 patients but our knowledge of clinical
characteristics of childhood covid-19 cancer patients is quite limited.
Many of our patients had fever, cough and sore throat as presenting
symptoms with majority of symptomatic patients having fever as
presenting complaints which is similar to earlier studies
conclusions15. Fever has been presenting
symptom\souts even in non-cancer pediatric population and seen in
70-80% of cases16. In our observation we found that
Childhood cancer patients with COVID-19 had minor complications and
likely to have good prospect of favorable prognosis. In our study,
majority of patients with solid malignancy, lymphoma and acute
lymphoblastic leukemia had minor complications. Only two patient from
this group required oxygen support out of 16 COVID-19 positive patients.
In majority of COVID-19 positive patients (n=15) fever subsided by day
five of COVID positive status and their clinical course was mild. Total
deaths in COVID 19 positive patients in our study was four comprising
about 21%. A study reported by Jacqueline Montoya et al. showed similar
death rate in childhood cancer patients of 10%. However this study
included few myeloid cancer patients (4%) as compared to our study,
which included 15.7% AML and majority of death during COVID 19 period
in our study were seen in AML patients only, accounting for 66.7% of
deaths17. In our study, deaths in COVID 19 positive
patients as compared to COVID 19 negative patients was statistically
significant Primarily deaths occurred to AML patients with COVID-19
positive status and they were treated with intensive chemotherapy
regimen and during course of time after both AML patients expired all
subsequent AML patients regardless of COVID status were treated with
adequate isolation.
Our study may have certain limitations owing to retrospective study
design. Our patient sample size may be not very large but it is very
well comparable with reference to earlier published COVID-19 studies in
childhood cancer patients. We were not able to perform COVID-19 related
inflammatory markers, chest radiography, computed tomography scan for
all COVID-19 positive patients in our setting as ours is not designate
COVID hospital as per government guidelines. All COVID-19 positive
patients with immediate intensive medical requirement were transferred
on priority basis to designate COVID-19 hospital ICU.