Clinical presentation, management, and outcomes of coronavirus disease 2019 infection in children on active therapy for cancer and posthematopoietic stem cell transplantation: Experience from a tertiary care center

BACKGROUND: Coronavirus disease 2019 (COVID-19), is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). Limited data on presentation, management and outcomes of COVID-19 in children with cancer and post-hematopoietic stem cell transplantation (HSCT) from Saudi Arabia is available. AIM: The primary aim of the study is to evaluate and describe presenting signs, symptoms, and severity of COVID 19 infection in pediatric patients with cancer and post HSCT, whereas the secondary aims are to assess COVID-19 management strategies and to assess outcomes in terms of treatment delays and mortality. METHOD: Retrospective study in children ≤ 14 years of age, who are on-active therapy for cancer or post-HSCT during the period March 2020 to July 2022. RESULTS: A total 45 cases with confirmed COVID-19 infection reported in children with cancer and post-HSCT. There were 29 male (64%) and 16 female (36%) cases, and median age of 7 years (1–14 yrs.) at the time of COVID-19 confirmed diagnosis was observed. Acute lymphoblastic leukemia, is the major diagnosis in 18 cases (40%) and all patients on active treatment course with majority of the cases being symptomatic, 78% (n = 35), with fever being the most common reason in 28 cases (80%). Main management was through home isolation in 78%, while hospitalization required in 12 % (10). Primary disease treatment remained uninterrupted in 56% (26), while treatment delays observed in 19 patients (42%). All patients in our study had smooth and complete recovery form COVID-19 infection. At a mean follow-up of 12.0 months (2.0–25.7 months), no morbidities or mortality to report. CONCLUSION: Our experience shows mild clinical symptoms and less severe disease course, which is comparable to international experience. Cancer treatment delays emerged as the only major impact, with no impact on the primary cancer progression or relapse at a two-year follow-up seen. Multi-institutional observational studies may enable evaluation of disease-free survival in larger cohort and could address long COVID symptoms in children.