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COVID-19 Infection in Children with Acute Lymphoblastic Leukemia Receiving Maintenance Therapy: Don’t Discount the Risk
  • +12
  • Alissa Kahn,
  • Elizabeth Davis S,
  • Caroline Caudill,
  • Isaac Martinez,
  • Julienne Brackett,
  • Archana Sharma,
  • Carla Schwalm,
  • Ann Kebede,
  • David Dickens,
  • Joshua Richman,
  • Susan Colace,
  • Smita Bhatia,
  • Julie Wolfson,
  • Jennifer Levine,
  • Emily Johnston
Alissa Kahn
Saint Joseph’s University Medical Center
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Elizabeth Davis S
The University of Alabama at Birmingham
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Caroline Caudill
The University of Alabama at Birmingham
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Isaac Martinez
The University of Alabama at Birmingham
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Julienne Brackett
Texas Children's Hospital
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Archana Sharma
Rutgers Cancer Institute of New Jersey
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Carla Schwalm
Bronson Methodist Hospital
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Ann Kebede
Nationwide Children's Hospital Hematology Oncology & Blood and Marrow Transplant
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David Dickens
The University of Iowa
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Joshua Richman
The University of Alabama at Birmingham
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Susan Colace
Nationwide Children's Hospital Hematology Oncology & Blood and Marrow Transplant
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Smita Bhatia
The University of Alabama at Birmingham
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Julie Wolfson
The University of Alabama at Birmingham

Corresponding Author:jwolfson@uabmc.edu

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Jennifer Levine
Children's National Hospital Center for Cancer and Blood Disorders
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Emily Johnston
The University of Alabama at Birmingham
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Abstract

Background: Unlike other pediatric cancers, acute lymphoblastic leukemia (ALL) treatment includes a prolonged maintenance phase during which children typically resume regular activities. As COVID-19 transmission persists despite the end of the public health emergency declaration, physicians need data regarding the impact of COVID-19 in this population to guide families in managing risk. Procedure: The Pediatric Oncology COVID-19 Case Report (POCC) collected de-identified clinical and sociodemographic data on children with cancer and COVID-19. This subset analysis compares 481 children (≤21yo at COVID-19 infection) with ALL in maintenance (ALL-MTN) to other children with cancer and COVID-19 (n=1,190). Results: Children in ALL-MTN had fewer hospitalizations, (23% vs 29%, p=0.01), intensive care unit admissions (ICU: 3% vs 5%, p=0.01), and were less likely to die (0% vs 2%, p=<0.01). However, they more often had cancer therapy changed (50% vs 33%, p=<0.01). Lower odds of hospitalization and ICU admission persisted in multivariable analyses adjusting for age, race/ethnicity, insurance, ANC, and comorbidities. There were independent associations among children in ALL-MTN with sociodemographic factors (Hispanic ethnicity, public insurance) and clinical characteristics (comorbid conditions, neutropenia) and both hospitalization and ICU admission. Vaccination decreased odds of hospitalization. Conclusions: Children in ALL-MTN continue to have significant COVID-19 risks, with less hospitalization and ICU admission but more therapy changes than other children with cancer. These risks should be addressed when discussing participation in activities (school, camp, sports, etc.), prevention (COVID-19 vaccination) and mitigation (masking) strategies. The high level of therapy modifications could have long-term consequences and should continue to be followed.