Clinical Features and Risk Factors Associated With Multisystem Inflammatory Syndrome in Children With Cancer and COVID-19
Authors: Martin Samantha D. , Davis Elizabeth S. , Dai Chen , Boal Lauren H. , Araya Brook , Brackett Julienne , Dickens David , Kahn Alissa , Martinez Isaac , Sharma Archana , Schwalm Carla , Aguayo-Hiraldo Paibel , Bhatia Smita , Levine Jennifer M. , Johnston Emily E. , Wolfson Julie A. ,   Pediatric Oncology COVID-19 Case Consortium, Aftandilian Catherine , Agrawal Anurag K. , De Angulo Guillermo , Aristizabal Paula , Bailey Kayleen , Bardwell Jenna K. , Becton David L. , Bemrich-Stolz Christina J. , Boal Lauren H. , Boston Catherine W.H. , Bradﬁeld Scott M. , Caywood Emi H. , Cohn Shannon M. , Colace Susan I. , Coven Scott L. , Cramer Stuart L. , Cuglievan Branko , Dargart Jamie L. , Daghistani Doured , Dhir Aditi , Dickens David S. , Dumitriu Anca , Eslin Don E. , Esquilin Jose M. , Feinberg Shari L. , Ferdjallah Asmaa , Fernandez Karen S. , Fixler Jason , Foley Jessica M. , Gampel Bradley H. , Glasser Chana L. , Goodman Jessica F. , Gotesman Moran , Gowans L. Kate , Gupta Ajay , HaDuong Josephine H. , Halpern Steven L. , Hara Harneet K. , Hartman Lisa R. , Herring Katye L. , Hesko Caroline S. , Aguayo-Hiraldo Paibel , Hoeft Alice K. , Hu Caroline Y. , Huo Jeffrey S. , Ikeda Alan K. , Isakoff Michael S. , Jain Akshat , Kahn Alissa R. , Kothari Prachi D. , Krajewski Jennifer A. , Kram David E. , Krystal Julie I. , Kyono Wade T. , Langevin Mary A. , Hayes-Lattin Brandon , Law Jason , Levine Jennifer M. , Lorenzana Adonis N. , Lotterman Craig D. , Majlessipour Fataneh , Marri Preethi R. , Massey Gita V. , Monteleone Philip M. , Moskop Amy M. , Mowbray Catriona , Navalkele Pournima D. , Olson Janice F. , Ostrodka Leanne , O’suoji Chibuzo C. , Patel Pratik A. , Pawlowska Anna , Sechser Perl Anna , Pinchinat Ashley E. , Prasad Pinki K. , Rangaswami Arun A. , Raulji Chittalsinh M. , Rico Juan F. , Saha Aniket , Salman Emad K. , SantaCruz Nadine P. , Sarangi Susmita N. , Schwalm Carla M. , Sharma Archana , Shaw Peter H. , Simon David C. , Slayton William B. , Smith Amy A. , Smitherman Andrew B. , Sorge Caryn E. , Sun Jessica M. , Symons Heather J. , Tal Adit , Thomas Stefanie M. , Tran Hung C. , Troutman Jacob A. , Turcotte Lucie M. , Valdez Jessica M. , Varela Carly R. , Whipple Nicholas S. , Wilkes Jennifer J. , Woods-Swafford Wendy , Yim Yung S. , Zhang Yaoping 
Published: May 2023

Importance

Little is known about the risk of post–COVID-19 multisystem inflammatory syndrome in children (MIS-C) in the setting of childhood cancer.

Objective

To evaluate factors associated with MIS-C and describe the clinical course of COVID-19 in the setting of MIS-C.

Design, Setting, and Participants

Multisite observational cohort study of a registry representing more than 100 US pediatric oncology sites. All included patients were registered between April 1, 2020, and May 18, 2022. Sites submitted deidentified data surrounding sociodemographics, cancer diagnosis and treatment, and COVID-19 course (symptoms, maximum support required, outcome). Patients with MIS-C (n = 24) were compared with matched controls (n = 96). Children (&amp;lt;21 years) with cancer who developed COVID-19 while receiving cancer treatment or within 1 year of completing treatment were characterized based on their development of MIS-C.

Exposures

(1) Clinical and sociodemographic characteristics of children with cancer and COVID-19; and (2) MIS-C.

Main Outcomes and Measures

(1) Development of MIS-C among children with cancer and COVID-19; and (2) symptoms and disease severity associated with MIS-C.

Results

Among 2035 children with cancer and COVID-19, 24 (1.2%) developed MIS-C. COVID-19 occurred at a median (IQR) age of 12.5 (5.5-17.1) years in those with MIS-C and 11 (6-16) years among matched controls (P = .86). The majority of children with MIS-C had a hematologic cancer (83.3% [n = 20]), were publicly insured (66.7% [n = 16]), and were Hispanic (54.2% [n = 13]). Half (n = 12) had 1 or more noncancer comorbidity. Those with comorbidities were more likely to develop MIS-C than those without (odds ratio [OR], 2.5 [95% CI, 1.1-5.7]). Among children with MIS-C, 100% (n = 24) were admitted to the hospital and 54.2% (n = 13) to the intensive care unit (ICU), while COVID-19 contributed to the death of 20.1% (n = 5); cancer therapy was changed in 62.5% (n = 15). Compared with matched controls, those with MIS-C had higher odds of symptoms classified as systemic (OR, 4.7 [95% CI, 1.4-15.8]) or gastrointestinal (OR, 5.0 [95% CI, 1.7-14.6]) along with higher odds of hospitalization (OR, 42.9 [95% CI, 7.1-258]), ICU admission (OR, 11.4 [95% CI, 3.6-36.4]), and changes to cancer therapy (OR, 24.9 [95% CI, 6.5-94.8]).

Conclusions and Relevance

In this cohort study among children with cancer and COVID-19, those with MIS-C had a more severe clinical course than those without MIS-C. The risk of MIS-C and its severity are important to consider as clinicians monitor patients with COVID-19. These findings can inform their conversations with families regarding COVID-19 risks and the benefits of prevention strategies that are pharmacologic (vaccination) and nonpharmacologic (masking), as well as treatment (antivirals, monoclonal antibodies).