Table 4.
COVID-19 in children following HCT: Comparison of the current study to other multicenter studies that reported at least some data on children following HCT (including at least 10 patients).
| Current study | Bhatt TCT 2022 (14) | Daudt BMT 2021 (15) | Zama Ann Hem 2022 (30) | Mukkada Lanc Onc 2021 (22) | Bailey Curr Onc 2022 (16) | Ljungman Leuk 2021 (6) | |
|---|---|---|---|---|---|---|---|
| Location | Multinational EBMT study | North and South America CIBMTR | Brazil | Multicenter Italian study | Multinational Global Registry | Review, 18 case reports and case series | Multinational EBMT study |
| Study period | March 2020–16th December 2021 | March 27 2020 - May 7 2021 | 29th March–1st September 2020 | March 2020–August 2021 | 15th April 2020–February 2021 | Until June 2021 | Until 31st July 2020 |
| Patient population | Children post-HCT | Children post-HCT | Children and adults post-HCT | Children with cancer and post-HCT | Children with cancer and post-HCT | Children and adults post-HCT | Children and adults post-HCT |
| Non-malignant disease proportion | 33/89 (37%) | 50/135 (37%) in allo-HSCT | 11/24 (46%) | 8/23 (35%) | 12/81 (14.8%) | NA | 28/382 (7.3%) (T) |
| Number of patients | 89 | 167 | 24 children; 62 adults | 153 children, 23/153 post-HSCT | 81 children post-HSCT; 1419 children with cancer | 54 children; 1285 adults | 32 (8.4% <18 years) 350 adults |
| Median age (min-max) years in children | 9 (1–18) | Allo: 15 (range <1-21) Auto: 7 (range 1-21) | 6.5 (0–17) | 7 (0–17) (T) | 8 (IQR 4–13) (T) | 0.6–17 | 9.5 (1.0–16.9) |
| Males | 52 (58%) | 106 (64%) | 14 (58.3%) | 86 (56.2%) (T) | 891/1500 (59.4%) (T) | 19/30 (63%) | 236/382 (61.8%) (T) |
| HCT type | 85 (96%) allo; 4 (4%) auto | 135 allo; 32 auto | 22 (92%) allo; 2 (8%) auto | 19 (83%) allo; 4 (17%) auto | allo and auto, numbers NA | allo | 236 allo T (29 children); 146 auto T (3 children) |
| Time since HCT to COVID (min-max) | 7 months (0–181) | Allo: 15 (IQR 7-45); Auto: 16 (IQR 6-59) months | 7 (0–216) (T) months | 219 (50– 3910) days | 6/81 (7.4%; <30 days); 13/81 (16%; 31-99 d); 20/81 (24.7%; 100-300 d); 31/81 (38.3%; >300 d); 11/81 (13.6% unknown) | 0–41 months | 17.9 (−0.9 to 350.3) (T) months |
| Fever | 36/84 (43%) | NA | 5 (21%) | 40 (75%) (T) | 619/1500 (41.3%) (T) | 17/30 (57%) | 257/382 (67.3%) (T) |
| Respiratory symptoms | 26/85 (31%) cough | NA | URT 10 (42%), LRT 4 (17%) | 10 (19%) (T) | 356/1500 (23.7%) cough (T) | 8/30 (27%) cough | 209/382 (54.7%) (cough 209 (54.7%); URT 106 (27.7%) (T) |
| Diarrhea/ Gastrointestinal symptoms | 9/84 (11%) | NA | 1 (4%) | 11 (21%) (T) | 152/1500 (10.2%) (T) | 3/30 (10%) | 52/382 (13.6%) (T) |
| Asymptomatic | 35/85 (41%) | 146/167 (87%) mild/asymptomatic | 8 (33%) | 9/19 (47.4%) allo 3/4 (75%) auto | 30/76 (39.5%) | NA | 34/382 (8.9%) (T) |
| Severe disease | 9 (10%) ICU care | 6/167 (4%) severe disease (mechanical ventilation) | 8 (33%) severe/ critical | 3/23 (13%) moderate/ severe/ critical; 2/23 (8.7%) ICU | 16/76 (21.1%) severe/critical | 7/27 (26%) ICU care | 80/356 (22.5%) ICU care (T) |
| Death | 7 (8%) | 10/167 (6%) | 5 (21%) | 3/153 (1.9%; due to disease progression). 0/23 in HSCT | 83/1500 (6.3%) (T) | 5/54 (9.3%) | 3/32 (9.4%) |
| Risk factors for mortality or severe disease | Severe disease course in allo-HCT (ICU/mortality): chronic GVHD, non-malignant disease, immune suppressive treatment and specifically mycophenolic acid (MMF), moderate risk based on immunodeficiency scoring index (vs. low risk), fever, cough, coinfection, pulmonary radiological findings, low Lansky score, high C-reactive protein levels | 45-day survival lower among recipients transplanted in the centers outside the US and those transplanted between 2014-2020 versus 2000-2013 | Mortality: male sex in children; symptomatic infection and Eastern Cooperative Oncology Group Performance Status (ECOG) (T); higher survival in children vs. adults; | Factors associated with moderate, severe, and critical disease: Infections occurring early (<60 days) after the diagnosis or after SCT | Severe disease: low-income or lower-middle-income or upper-middle income country, age 15–18 years vs. younger children, lymphopenia, neutropenia, intensive immune suppressive treatment (among them recent HCT) (T) | NA | No difference in age between the children who died or survived; higher survival in children vs. adults; Mortality (T): older age, higher ISI group, worse performance status. In allo-HCT and auto-HCT separately: older age |
EBMT European Blood and Marrow Transplantation Society, CIBMTR Center for International Blood and Marrow Transplant Research, NA non-available for HCT children, URT upper respiratory tract symptoms, LRT low respiratory tract symptoms, ICU intensive care unit, ISI immune suppression index, GVHD Graft versus host disease, T total cohort, including children and adults in the mixed studies; or children following HCT together with children with other diagnoses in the pediatric studies including children with malignant diseases and HCT.
Percentages are presented in pediatric population HCT if available; and if not – in total population (T)