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.