Risk factors for a severe disease course in children with SARS-COV-2 infection following hematopoietic cell transplantation in the pre-Omicron period: a prospective multinational Infectious Disease Working Party from the European Society for Blood and Marrow Transplantation group (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH) study - Report - MDSpire
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Risk factors for a severe disease course in children with SARS-COV-2 infection following hematopoietic cell transplantation in the pre-Omicron period: a prospective multinational Infectious Disease Working Party from the European Society for Blood and Marrow Transplantation group (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH) study
Risk Factors for Severe COVID-19 in Pediatric Post-HCT Patients Pre-Omicron
Overview
This multinational study analyzed 89 pediatric hematopoietic cell transplantation (HCT) recipients diagnosed with SARS-CoV-2 before December 2021. Severe COVID-19, defined as ICU admission or death, occurred in 10% of cases and was associated with neutropenia, lymphocytopenia, and ongoing immunosuppressive therapy.
Background
COVID-19 generally causes mild disease in immunocompetent children, with low ICU admission and mortality rates. However, children with underlying conditions, including those post-hematopoietic cell transplantation (HCT), are at increased risk for severe outcomes. Prior data showed high mortality (~30%) in adult HCT recipients during the first pandemic wave, but pediatric risk factors for severe COVID-19 post-HCT remain poorly characterized. This study aimed to describe clinical characteristics and identify risk factors for severe disease in children post-HCT infected with SARS-CoV-2 during the pre-Omicron era.
Data Highlights
Characteristic
Value
Number of children
89
Median age (years)
9 (range 1–18)
Male sex
58%
Allogeneic HCT recipients
96%
Median time from HCT to SARS-CoV-2 infection (months)
7 (range 0–181)
Underlying acute leukemia
52%
Comorbidities present
24%
Asymptomatic infection
42%
Hospitalized
55%
ICU admissions
10%
Oxygen therapy required
10%
Non-invasive ventilation
3%
Invasive ventilation
6%
Key Findings
Severe COVID-19 (ICU admission or death) occurred in 10% of pediatric post-HCT patients with SARS-CoV-2 infection.
All children admitted to ICU were neutropenic and most were lymphocytopenic at diagnosis.
Ongoing immunosuppressive therapy at the time of infection was common among severe cases.
Common clinical manifestations included fever, cough, and upper respiratory symptoms; 42% were asymptomatic.
Hospitalization was required in 55% of cases, with 43% of hospitalizations directly due to COVID-19.
Coinfections occurred in 27% of children, predominantly viral.
Clinical Implications
Clinicians should closely monitor pediatric HCT recipients who develop neutropenia or lymphocytopenia and are receiving immunosuppressive therapy, as these factors increase risk for severe COVID-19. Early identification and management of SARS-CoV-2 infection in this vulnerable population are critical to improve outcomes. Routine vaccination and preventive strategies remain important, although none of the children in this cohort were vaccinated.
Conclusion
In pediatric HCT recipients during the pre-Omicron era, neutropenia, lymphocytopenia, and immunosuppressive therapy were key risk factors for severe COVID-19. These findings highlight the need for vigilant monitoring and tailored management strategies in this high-risk group.
References
European Society for Blood and Marrow Transplantation & Spanish Hematopoietic Stem Cell Transplantation Group 2022 -- Pediatric SARS-CoV-2 Post-HCT Outcomes
by Dina Averbuch, Rafael de la Camara, Gloria Tridello, Nina Simone Knelange, Tatiana A. Bykova, Marianne Ifversen, Veronika Dobsinska, Mouhab Ayas, Amir Ali Hamidieh, Herbert Pichler, Antonio Perez-Martinez, Simone Cesaro, Mikael Sundin, Isabel Badell, Peter Bader, Jan-Erik Johansson, Oana Mirci-Danicar, Petr Sedlacek, Catherine Paillard, Brenda Gibson, Sarah Lawson, Nicolaus Kroeger, Selim Corbacioglu, Malgorzata Mikulska, Jose Luis Piñana, Jan Styczynski, Per Ljungman
