COVID-19 Disrupts Chemo in Kids With ALL, Lymphoblastic Lymphoma

COVID-19 often disrupts chemotherapy in pediatric patients with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LLy), according to a case series published in JAMA Network Open.

For this study, researchers looked at data from 308 pediatric patients with newly diagnosed ALL/LLy who were treated at St. Jude Children’s Research Hospital in Memphis, Tennessee, and its affiliate sites. The patients were treated with the Total XVII protocol (ClinicalTrials.gov Identifier: NCT03117751) from March 2020 to June 2022.

A total of 110 patients were diagnosed with COVID-19. Sixty-two cases were mild or moderate, 17 were asymptomatic, and 7 cases were severe.

The researchers noted that the rate of COVID-19 in this cohort (36%) was “substantially higher than the cumulative incidence of 18% in our general pediatric population,” but this was likely a result of the routine COVID-19 testing in the study cohort.

The researchers also noted that patients who had COVID-19 tended to be older and were more likely to be Hispanic, and severe COVID-19 was more common in adolescents than in younger patients.

The most common COVID-19 symptoms were cough (63%), fever (47%), and rhinorrhea (42%). Two patients developed thrombosis, and 2 had pancreatitis (1 of whom also had thrombosis).

Thirty-six patients were admitted to the hospital for COVID-19, and 4 patients were admitted to the intensive care unit. None of the patients required mechanical ventilation, developed multisystem inflammatory syndrome, or died during the observation period.

Eleven patients received remdesivir as COVID-19 treatment, and 3 patients with severe disease received dexamethasone. None of the patients received tixagevimab and cilgavimab.

In the 88 patients with available data, the median time to SARS-CoV-2 clearance was 31.5 days (range, 11-126 days).

Most patients (n=101) developed COVID-19 during maintenance chemotherapy. For 87% of patients with COVID-19, chemotherapy was held until clinical improvement and/or completion of antiviral therapy.

Patients with severe COVID-19 had chemotherapy held more often and for longer, but chemotherapy was also held in 76% of patients with few symptoms or asymptomatic COVID-19. Chemotherapy was held for a median of 8 days during the first SARS-CoV-2 infection.

Eleven patients had a second SARS-CoV-2 infection. The median time between the first and second infection was 8.8 months (range, 2.5-19.3 months). Nine of these patients had chemotherapy held due to their second infection, and the median total chemotherapy interruption for this group was 22 days.

“The findings of this study suggest that although severe COVID-19 was rare, most patients experienced chemotherapy interruptions regardless of COVID-19 severity, which may affect survival outcomes for patients with ALL/LLy,” the researchers wrote.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Cancer Therapy Advisor