ABSTRACT
Background: Children with cancer are at risk of severe COVID-19 infections. Unique from adults, children are susceptible to Multisystem Inflammatory Syndrome in Children (MIS-C). Between 0.01% and 0.06% of children infected with COVID-19 develop MIS-C. However, little is known about MIS-C in children with cancer. Objectives: Among children with cancer and COVID-19, evaluate the rate of MIS-C along with the clinical and sociodemographic characteristics and clinical course of those who develop MIS-C. Design/Method: The Pediatric Oncology COVID-19 Case Report (POCC) collects de-identified clinical and sociodemographic data on children with cancer infected with COVID-19 from >100 US institutions. This analysis examines children with cancer (<21y at COVID-19 infection) who developed MIS-C. The following are described: MIS-C prevalence;clinical characteristics (cancer diagnosis, blood or marrow transplantation [BMT] status, disease status [new diagnosis vs. relapsed/refractory], time from last chemotherapy), and sociodemographic characteristics (age, sex, race/ethnicity, insurance);clinical course of COVID-19 (symptoms, level of support, changes in cancer therapy). Results: Among 1,279 children with cancer and COVID-19, 23 (1.8%) developed MIS-C at a median age of 12 (interquartile range [IQR] 4-17), among whom 12 (52%) were Hispanic and 15 (65%) publicly insured. Nineteen (83%) had hematologic malignancies and 3 (13%) had received a BMT. At the time of infection, children had received chemotherapy a median of 14d (IQR: 4-52) prior, and 7 (31%) patients had an ANC <500. The most common symptoms were: systemic symptoms (n = 18, 78%), respiratory (n = 13, 57%) and gastrointestinal (n = 10, 44%). Eighteen (78%) children were admitted to the hospital, 13 (57%) to the intensive care unit (ICU). Five (22%) required mechanical ventilation, 3 (13%) hemodialysis, and one (4%) extracorporeal membrane oxygenation (ECMO). Fourteen (61%) had their cancer-directed therapy changed. Seven (30%) children with MIS-C died;COVID-19 contributed to the death in five children while two died because of their cancer. Conclusion: Children with cancer and COVID-19 can develop MIS-C, potentially at higher rates than in the general pediatric population. Additionally, the majority of children with MIS-C and COVID-19 have severe disease as indicated by a high hospitalization rate, and many of these patients require ICU admission and unfortunately die related to complications. More than half also have their cancer therapy changed, which has unknown implications on their long-term cancer outcomes. Pediatric oncologists can consider these risks as they evaluate children with cancer and COVID-19 and as they advise families regarding their risks of COVID-19 and the benefits of vaccination.