COVID-19 Disease in Children With ALL Receiving Maintenance Therapy: Do Not Discount the Risk
Authors: Kahn Alissa R. , Davis Elizabeth S. , Dai Chen , Caudill Caroline V. , Martinez Isaac , Brackett Julienne , Sharma Archana , Schwalm Carla , Kebede Ann , Dickens David S. , Richman Joshua , Colace Susan ,   on behalf of the POCC Consortium, Araya Brook , Bhatia Smita , Wolfson Julie A. , Levine Jennifer M. , Johnston Emily E. , 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 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. , MCR  , Krystal Julie I. , Kyono Wade T. , Langevin Mary A. , CFNP  , Hayes-Lattin Brandon , Law Jason , Levine Jennifer M , Lorenzana Adonis Napoleon , Lotterman Craig D. , Majlessipour Fataneh , Marri Preethi R. , Massey Gita V. , Monteleone Philip M. , Moskop Amy M. , Mowbray Catriona , CPHON  , Navalkele Pournima D. , Olson Janice F. , Ostrodka Leanne , O’suoji Chibuzo C. , Patel Pratik A. , Pawlowska Anna , Perl Anna Sechser , Pinchinat Ashley E. , Prasad Pinki K. , Rangaswami Arun Atreiya , Raulji Chittalsinh M. , Rico Juan Felipe , Saha Aniket , Salman Emad Kassim , 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: August 2024

PURPOSE
Unlike most childhood cancers, therapy for ALL includes a prolonged maintenance phase during which children typically resume regular activities. Physicians need data regarding the persistent impact of COVID-19 in this population to help guide families after the pandemic.

METHODS
The Pediatric Oncology COVID-19 Case Report (POCC) collects deidentified data (sociodemographics, clinical data [cancer, COVID-19 course]) on children, adolescents, and young adults with cancer and COVID-19 from 104 US pediatric oncology institutions. The analysis presented here compares children (≤21 years) with ALL in maintenance (ALL-MTN) with all other children with cancer and COVID-19. Multivariable analyses adjust for age, race/ethnicity, insurance, absolute neutrophil count at the time of infection, vaccination, and comorbidities.

RESULTS

Compared with other children reported to POCC (n = 1,190), those in ALL-MTN (n = 481) were less often hospitalized (23%
v
29%,
P
= .01) or admitted to the intensive care unit (ICU: 3%
v
5%,
P
= .01); these findings persisted in multivariable analysis (hospitalization: odds ratio [OR], 0.7 [95% CI, 0.6 to 0.9]; ICU: OR, 0.5 [95% CI, 0.2 to 0.8]). However, cancer-directed therapy was changed more often for children in ALL-MTN (50%
v
33%,
P
≤ .01; OR, 2.0 [95% CI, 1.6 to 2.5[). Vaccination was an independent prognostic factor in our multivariable model, decreasing odds of hospitalization (OR, 0.7 [95% CI, 0.5 to 0.9]).

CONCLUSION
Children in ALL-MTN required fewer hospitalizations and ICU admissions but more therapy modifications than other children with cancer. Vaccination against COVID-19 reduced the odds of hospitalization.