Background: Data on the outcome and risk factors of pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: We aimed to describe risk factors for a severe course and mortality. Method: In this nationwide study, data were collected retrospectively from 28 transplant centers. Results: One hundred ninety-six children [(63.8% male; median age 8.75 (IQR, 4.86-14.30)] who received allogeneic (n: 184, 93.9%) or autologous (n: 12, 6.1%) HSCT were included. The median time from HSCT to SARS-CoV-2 infection was 207.5 days (IQR, 110.2-207.5). The most common clinical manifestation was fever (58.2%), followed by cough (33.7%); 43 cases (21.9%) were asymptomatic. Lower respiratory tract disease (LRTD) and multisystem inflammatory syndrome in children (MIS-C) developed in 58 (29.6%) and 8 (4.1%) patients, respectively. Twenty-six patients (13.3%) required ICU admission. Nine patients died at a median of 17 days (min-max 1-33) after COVID-19 diagnosis, 6 of whom died due to the disease, with a COVID-19 lethality rate of 3.1%. The 6-week overall survival was 95.4% (95% CI 92.5-98.3). Multivariate analysis found that HSCT with a mismatched donor (OR, 8.98, p: 0.039) and LRTD (OR, 61.55, p: 0.001) were independent risk factors for ICU admission; MIS-C (OR, 9.55, p: 0.044) and lymphopenia (OR, 4.01, p: 0.030) at diagnosis were risk factors for mortality. Conclusion: Overall mortality was lower in children than in adult counterparts, and HSCT with a mismatched donor, lymphopenia, LRTD, MIS-C and ICU admission were important risk factors for adverse outcomes.

Aim: To determine pre- and post-transplant appetite and nutritional status of children undergoing stem cell transplantation. Methods: This study was conducted between November 2018 and November 2020 with 25 children, aged 8-18 years, diagnosed with cancer without secondary disease and scheduled for stem cell transplantation. Time points: seven days pre-stem cell transplant (T1); transplant day (T2); Day 1 post-transplantation (T3); Day 14 post-transplantation (T4); and Day 30 post-transplantation (T5). Measurements for treating pediatric anorexia and cachexia include: height, mid-upper arm circumference (MUAC); body mass index (BMI); and the Pediatric Functional Assessment Scale (Peds-FAACT). Results: 52% of patients were female, and mean age was 13.2 years. Acute lymphoblastic leukemia was diagnosed in 32% of the children. There was a statistically significant difference between the means of body weight over time (p<0.001). By Day 14 post-transplantation, 61% of subjects (n=14) had lost > 5% of body weight. There was a statistically significant difference between distributions of change in food taste over time, and distribution of change in food smell (p<0.001, p<0.001, respectively). Conclusions: Clinical nutrition teams should closely follow the children’s nutritional status, plan appropriate nutritional treatment, perform nutritional care, and evaluate anthropometric measurements.