Pediatric cancer patients fare worse with COVID-19 than children without cancer

Research from a major international effort shows that 20% of children with cancer infected with SARS-CoV-2 develop serious infections. In general studies of children, only 1-6% have reported serious infections. The results come from the Global Registry of COVID-19 in Childhood Cancer, which was launched by St. Jude Children’s Research Hospital and the International Society of Pediatric Oncology (SIOP). The registry collects data on the impact of the pandemic on this unique patient population. The findings are published today in The Lancet Oncology.

Results from the registry indicated that in addition to more serious or critical infections, pediatric cancer patients were more likely to be hospitalized and die than other children. The pandemic also disrupted cancer treatment. These effects were observed more significantly in low- and middle-income countries, where the risk of serious or critical illness from COVID-19 was almost 6 times greater than in high-income countries.

The results clearly and definitively show that children with cancer do worse with COVID-19 than children without cancer. This global collaboration will help clinicians make evidence-based decisions about prevention and treatment, which unfortunately remain relevant as the pandemic continues.”

Sheena Mukkada, MD, corresponding author, St. Jude Departments of Global Pediatric Medicine and Infectious Diseases

A greater burden for pediatric cancer patients

This is the first multinational study describing the outcomes of a large cohort of children and adolescents with cancer or hematopoietic stem cell transplantation and laboratory diagnosis of COVID-19. The register remains open and enrolls children under 19 years of age.

The analysis looked at 1,500 children from 131 hospitals in 45 countries from April 15, 2020 to February 1, 2021. This is before vaccinations become available for older children in some parts of the world, as well as before the emergence of certain disease variants, including delta, which are responsible for are for the new wave and have become a major global problem.

The study found that 65% of patients were hospitalized and 17% required admission or transfer to a higher level of care. It also showed that 4% of patients died due to COVID-19 infections, compared to 0.01-0.7% mortality reported in general pediatric patients. Cancer care was also affected. Cancer therapy was adjusted in 56% of patients and 45% were withheld from chemotherapy while their infections were being treated.

“By working together to create this global registry, we have enabled hospitals around the world to quickly share and learn how COVID-19 affects children with cancer,” said the paper’s co-author, Professor Kathy. Pritchard-Jones, SIOP President. “The results are reassuring that many children can safely continue their cancer treatment, but they also highlight important clinical features that may predict a more severe clinical course and the need for greater vigilance for some patients.”

A global pandemic and a global response

The registry suggests biological factors likely to influence how children with cancer respond to COVID-19. These include the functioning of the immune system and the underlying disease. Analysis also showed that results vary around the world, although the registry does not pinpoint causes. This variation could be due to many factors, including disruptions from the pandemic, access to care and resources, or delays in the diagnosis of infections.

The results of the registry are a call to action to address inequalities in access to protective and effective treatment measures against the COVID-19 pandemic worldwide.

“Understanding a global crisis like COVID-19 requires our entire pediatric cancer community around the world to come together to respond,” said senior author Carlos Rodriguez-Galindo, MD, St. Jude Global director. “The impact of this disease has been felt in all corners of the world, but especially in low- and middle-income countries compared to high-income countries. There are crucial differences based on where a child lives. This registry is a tool that helps us understand what that means for children with cancer everywhere.”

The registry continues to enroll patients and continues to add new countries. It includes freely available data visualization tools so that anyone, anywhere, can access the information.

More information about COVID-19 and vaccination

Vaccinations against COVID-19 have been shown to be safe and effective in preventing severe forms of the disease, allowing patients to avoid hospitalizations and the need for mechanical ventilation. In the United States, vaccines are available and encouraged for children ages 12 and older. Vaccination is a way to protect not only yourself but your community, including those who are at high risk for serious illness, such as children with cancer.


St. Jude Children’s Research Hospital

Reference magazine:

Mukkada, S., et al. (2021) General characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. The Lancet Oncology.

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