“The children on intensive regimens didn’t necessarily fall into the more severe categories — for example, patients post–bone marrow transplant were represented in the dataset,” said Dr Bob Phillips, senior clinical academic at the Centre for Reviews and Dissemination, University of York, and honorary consultant in pediatric oncology, Leeds Children’s Hospital, U.K. (which was 1 of the leaders of the project). “For the children who had asymptomatic disease, they ranged from very neutropenic, to more immune-competent,” he added.

Based on this report, the U.K. changed its shielding guidelines for some children with cancer to recommend less stringent physical distancing. The findings are also backed up by another recently published paper looking at the effect of COVID-19 on children with cancer at Memorial Sloan Kettering Cancer Center in New York City; this study reported similarly mild disease in the majority of pediatric patients with cancer and COVID-19.4

“Both of these highlight the limitation of small data sets — but the signal from these is very reassuring in some aspects. This isn’t as overwhelming as we thought it would be,” said Dr Bhakta, who emphasized that the combination of smaller data sets is needed to make definitive conclusions. “We do have deaths in our data set; we are still analyzing [these] data to see whether there are risk groups within this childhood cancer community,” added Dr Bhakta.


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But presuming the trends in these early reports are backed up by evidence from larger studies, why could children with cancer be faring so well with COVID-19, when this outcome is the very opposite of what was initially feared?

“These are all speculations at the moment — what we have in children generally seems to be a different way of handling SARS-CoV-2. Children’s immune systems see coronaviruses all of the time anyway; kids seem to be better equipped to deal with it,” said Dr Phillips. “Another possible explanation is that we use pretty heavy immunosuppression in these patients — if a problem for severe disease is [an] overly enthusiastic inflammatory response, children with cancer simply can’t mount this, so they can’t present the disease state,” he noted.

Dr Phillips argued that there are still several unknowns regarding whether certain types of therapies — perhaps those less frequently used in children with cancer — may leave children more or less susceptible to COVID-19. These include some immunotherapies and tyrosine kinase inhibitors.

The St. Jude registry expects to publish a more comprehensive analysis of the data in the coming weeks, and the U.K. Pediatric Oncology Coronavirus Monitoring Project will keep adding to its data set and publishing updates.

References

  1. COVID-19 and Childhood Cancer Registry. Global Registry of COVID-19 in pediatric cancer. https://global.stjude.org/en-us/global-covid-19-observatory-and-resource-center-for-childhood-cancer/registry.html. Accessed August 3, 2020.
  2. UK Paediatric Oncology Coronavirus Cancer Monitoring Project. Paediatric oncology. https://ukcoronaviruscancermonitoring.com/paediatrics/. Accessed August 3, 2020.
  3. Children’s Cancer and Leukemia Group. Coronavirus data. https://www.cclg.org.uk/coronavirus-data. Data published on May 18, 2020. Accessed August 3, 2020.
  4. Boulad F, Kamboj M, Bouvier N, Mauguen A, Kung AL. COVID-19 in children with cancer in New York City [published online May 13, 2020]. JAMA Oncol. doi: 10.1001/jamaoncol.2020.2028