Flash Survey on SARS-CoV-2 Infections in Pediatric Patients on anti-Cancer Treatment
Identifieur interne : 000F90 ( Pmc/Corpus ); précédent : 000F89; suivant : 000F91Flash Survey on SARS-CoV-2 Infections in Pediatric Patients on anti-Cancer Treatment
Auteurs : Ondrej Hrusak ; Tomas Kalina ; Joshua Wolf ; Adriana Balduzzi ; Massimo Provenzi ; Carmelo Rizzari ; Susana Rives ; María Del Pozo Carlavilla ; Maria Eli Valerio Alonso ; Nerea Domínguez Pinilla ; Jean-Pierre Bourquin ; Kjeld Schmiegelow ; Andishe Attarbaschi ; Pernilla Grillner ; Karin Mellgren ; J. Ten Bosch Van Der Werff ; Rob Pieters ; Triantafyllia Brozou ; Arndt Borkhardt ; Gabriele Escherich ; Melchior Lauten ; Martin Stanulla ; Owen Smith ; Allen Eng Juh Yeoh ; Sarah Elitzur ; Ajay Vora ; Chi-Kong Li ; Hany Ariffin ; Alexandra Kolenova ; Luciano Dallapozza ; Roula Farah ; Jelena Lazic ; Atsushi Manabe ; Jan Styczynski ; Gabor Kovacs ; Gabor Ottoffy ; Marisa Felice ; Barbara Buldini ; Valentino Conter ; Jan Stary ; Martin SchrappeSource :
- European Journal of Cancer [ 0959-8049 ] ; 2020.
Abstract
Since the beginning of COVID-19 pandemics, it is known that the severe course of the disease occurs mostly among elderly, whereas it is rare among children and young adults. Comorbidities, in particular diabetes and hypertension, clearly associated with age, besides obesity and smoke are strongly associated with the need of intensive treatment and a dismal outcome. A weaker immunity of the elderly has been proposed as a possible explanation of this uneven age distribution. Along the same line, anecdotal information from Wuhan, China mentioned a severe course of COVID-19 in a child treated for leukemia.
We made a flash survey on COVID19 incidence and severity among children on anticancer treatment. Respondents were asked by email to fill in a short web based survey.
We received reports from 25 countries, where approximately 10,000 patients at risk are followed. At the time of the survey, over 200 of these children were tested, nine of whom were positive for COVID-19. Eight of the nine cases had asymptomatic to mild disease and one was just diagnosed with COVID-19. We also discuss preventive measures that are in place or should be taken as well as treatment options in immunocompromised children with COVID-19.
Thus, even children receiving anti-cancer chemotherapy may have a mild or asymptomatic course of COVID-19. While we should not underestimate the risk of developing a more severe course of COVID-19 than observed here, the intensity of preventive measures should not cause delays or obstructions in oncological treatment.
Url:
DOI: 10.1016/j.ejca.2020.03.021
PubMed: NONE
PubMed Central: 7141482
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PMC:7141482Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Flash Survey on SARS-CoV-2 Infections in Pediatric Patients on anti-Cancer Treatment</title><author><name sortKey="Hrusak, Ondrej" sort="Hrusak, Ondrej" uniqKey="Hrusak O" first="Ondrej" last="Hrusak">Ondrej Hrusak</name><affiliation><nlm:aff id="aff1">CLIP - Childhood Leukemia Investigation Prague</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Pediatric Hematology, Charles University and Univ. Hospital Motol, Prague, Czechia</nlm:aff></affiliation></author><author><name sortKey="Kalina, Tomas" sort="Kalina, Tomas" uniqKey="Kalina T" first="Tomas" last="Kalina">Tomas Kalina</name><affiliation><nlm:aff id="aff1">CLIP - Childhood Leukemia Investigation Prague</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Pediatric Hematology, Charles University and Univ. Hospital Motol, Prague, Czechia</nlm:aff></affiliation></author><author><name sortKey="Wolf, Joshua" sort="Wolf, Joshua" uniqKey="Wolf J" first="Joshua" last="Wolf">Joshua Wolf</name><affiliation><nlm:aff id="aff3">Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, USA</nlm:aff></affiliation></author><author><name sortKey="Balduzzi, Adriana" sort="Balduzzi, Adriana" uniqKey="Balduzzi A" first="Adriana" last="Balduzzi">Adriana Balduzzi</name><affiliation><nlm:aff id="aff4">Clinica Pediatrica Universita degli Studi di Milano Bicocca, Monza, Italy</nlm:aff></affiliation></author><author><name sortKey="Provenzi, Massimo" sort="Provenzi, Massimo" uniqKey="Provenzi M" first="Massimo" last="Provenzi">Massimo Provenzi</name><affiliation><nlm:aff id="aff5">Oncologia Pediatrica, Ospedale Papa Giovanni XXIII, Bergamo, Italy</nlm:aff></affiliation></author><author><name sortKey="Rizzari, Carmelo" sort="Rizzari, Carmelo" uniqKey="Rizzari C" first="Carmelo" last="Rizzari">Carmelo Rizzari</name><affiliation><nlm:aff id="aff6">Pediatric Hematology Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, ASST Monza</nlm:aff></affiliation></author><author><name sortKey="Rives, Susana" sort="Rives, Susana" uniqKey="Rives S" first="Susana" last="Rives">Susana Rives</name><affiliation><nlm:aff id="aff7">Hospital Sant Joan de Déu de Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Del Pozo Carlavilla, Maria" sort="Del Pozo Carlavilla, Maria" uniqKey="Del Pozo Carlavilla M" first="María" last="Del Pozo Carlavilla">María Del Pozo Carlavilla</name><affiliation><nlm:aff id="aff8">Hospital General Universitario de Albacete, Spain</nlm:aff></affiliation></author><author><name sortKey="Valerio Alonso, Maria Eli" sort="Valerio Alonso, Maria Eli" uniqKey="Valerio Alonso M" first="Maria Eli" last="Valerio Alonso">Maria Eli Valerio Alonso</name><affiliation><nlm:aff id="aff8">Hospital General Universitario de Albacete, Spain</nlm:aff></affiliation></author><author><name sortKey="Dominguez Pinilla, Nerea" sort="Dominguez Pinilla, Nerea" uniqKey="Dominguez Pinilla N" first="Nerea" last="Domínguez Pinilla">Nerea Domínguez Pinilla</name><affiliation><nlm:aff id="aff9">Hospital Virgen de la Salud, Spain</nlm:aff></affiliation></author><author><name sortKey="Bourquin, Jean Pierre" sort="Bourquin, Jean Pierre" uniqKey="Bourquin J" first="Jean-Pierre" last="Bourquin">Jean-Pierre Bourquin</name><affiliation><nlm:aff id="aff10">Department of Oncology and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Schmiegelow, Kjeld" sort="Schmiegelow, Kjeld" uniqKey="Schmiegelow K" first="Kjeld" last="Schmiegelow">Kjeld Schmiegelow</name><affiliation><nlm:aff id="aff11">Department of Peadiatrics and Adolescent Medicine, Rigshospitalet University Hospital, Copenhagen, Denmark</nlm:aff></affiliation></author><author><name sortKey="Attarbaschi, Andishe" sort="Attarbaschi, Andishe" uniqKey="Attarbaschi A" first="Andishe" last="Attarbaschi">Andishe Attarbaschi</name><affiliation><nlm:aff id="aff12">Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria</nlm:aff></affiliation></author><author><name sortKey="Grillner, Pernilla" sort="Grillner, Pernilla" uniqKey="Grillner P" first="Pernilla" last="Grillner">Pernilla Grillner</name><affiliation><nlm:aff id="aff13">Pediatric Oncology, Karolinska University Hospital, Sweden</nlm:aff></affiliation></author><author><name sortKey="Mellgren, Karin" sort="Mellgren, Karin" uniqKey="Mellgren K" first="Karin" last="Mellgren">Karin Mellgren</name><affiliation><nlm:aff id="aff14">Department of Pediatric Haematology and Oncology, Sahlgrenska University Hospital, Gothenberg, Sweden</nlm:aff></affiliation></author><author><name sortKey="Ten Bosch Van Der Werff, J" sort="Ten Bosch Van Der Werff, J" uniqKey="Ten Bosch Van Der Werff J" first="J." last="Ten Bosch Van Der Werff">J. Ten Bosch Van Der Werff</name><affiliation><nlm:aff id="aff15">UZ Brussels, Belgium</nlm:aff></affiliation></author><author><name sortKey="Pieters, Rob" sort="Pieters, Rob" uniqKey="Pieters R" first="Rob" last="Pieters">Rob Pieters</name><affiliation><nlm:aff id="aff16">Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Brozou, Triantafyllia" sort="Brozou, Triantafyllia" uniqKey="Brozou T" first="Triantafyllia" last="Brozou">Triantafyllia Brozou</name><affiliation><nlm:aff id="aff17">Department of Pediatric Oncology Hematology and Clinical Immunology Heinrich Heine University Dusseldorf</nlm:aff></affiliation></author><author><name sortKey="Borkhardt, Arndt" sort="Borkhardt, Arndt" uniqKey="Borkhardt A" first="Arndt" last="Borkhardt">Arndt Borkhardt</name><affiliation><nlm:aff id="aff17">Department of Pediatric Oncology Hematology and Clinical Immunology Heinrich Heine University Dusseldorf</nlm:aff></affiliation></author><author><name sortKey="Escherich, Gabriele" sort="Escherich, Gabriele" uniqKey="Escherich G" first="Gabriele" last="Escherich">Gabriele Escherich</name><affiliation><nlm:aff id="aff18">Klinik für Pädiatrische Hämatologie und Onkologie Universtitätsklinikum Eppendorf, Hamburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Lauten, Melchior" sort="Lauten, Melchior" uniqKey="Lauten M" first="Melchior" last="Lauten">Melchior Lauten</name><affiliation><nlm:aff id="aff19">University Hospital Schleswig-Holstein, Campus Lübeck, Germany</nlm:aff></affiliation></author><author><name sortKey="Stanulla, Martin" sort="Stanulla, Martin" uniqKey="Stanulla M" first="Martin" last="Stanulla">Martin Stanulla</name><affiliation><nlm:aff id="aff20">Department of Pediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany</nlm:aff></affiliation></author><author><name sortKey="Smith, Owen" sort="Smith, Owen" uniqKey="Smith O" first="Owen" last="Smith">Owen Smith</name><affiliation><nlm:aff id="aff21">National Children’s Cancer Service, Children’s Health Ireland at Crumlin, Dublin, Ireland</nlm:aff></affiliation></author><author><name sortKey="Juh Yeoh, Allen Eng" sort="Juh Yeoh, Allen Eng" uniqKey="Juh Yeoh A" first="Allen Eng" last="Juh Yeoh">Allen Eng Juh Yeoh</name><affiliation><nlm:aff id="aff22">Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore</nlm:aff></affiliation></author><author><name sortKey="Elitzur, Sarah" sort="Elitzur, Sarah" uniqKey="Elitzur S" first="Sarah" last="Elitzur">Sarah Elitzur</name><affiliation><nlm:aff id="aff23">Schneider Children's Medical Center of Israel</nlm:aff></affiliation></author><author><name sortKey="Vora, Ajay" sort="Vora, Ajay" uniqKey="Vora A" first="Ajay" last="Vora">Ajay Vora</name><affiliation><nlm:aff id="aff24">Great Ormond Street Hospital, London, UK</nlm:aff></affiliation></author><author><name sortKey="Li, Chi Kong" sort="Li, Chi Kong" uniqKey="Li C" first="Chi-Kong" last="Li">Chi-Kong Li</name><affiliation><nlm:aff id="aff25">Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Ariffin, Hany" sort="Ariffin, Hany" uniqKey="Ariffin H" first="Hany" last="Ariffin">Hany Ariffin</name><affiliation><nlm:aff id="aff26">University of Malaya Medical Centre, Kuala Lumpur, Malaysia</nlm:aff></affiliation></author><author><name sortKey="Kolenova, Alexandra" sort="Kolenova, Alexandra" uniqKey="Kolenova A" first="Alexandra" last="Kolenova">Alexandra Kolenova</name><affiliation><nlm:aff id="aff27">Department of Pediatric Hematology and Oncology, Comenius University, Bratislava, Slovakia</nlm:aff></affiliation></author><author><name sortKey="Dallapozza, Luciano" sort="Dallapozza, Luciano" uniqKey="Dallapozza L" first="Luciano" last="Dallapozza">Luciano Dallapozza</name><affiliation><nlm:aff id="aff28">The Cancer Centre for Children, The Children's Hospital at Westmead, Australia</nlm:aff></affiliation></author><author><name sortKey="Farah, Roula" sort="Farah, Roula" uniqKey="Farah R" first="Roula" last="Farah">Roula Farah</name><affiliation><nlm:aff id="aff29">LAUMC-Rizk Hospital, Beirut, Lebanon</nlm:aff></affiliation></author><author><name sortKey="Lazic, Jelena" sort="Lazic, Jelena" uniqKey="Lazic J" first="Jelena" last="Lazic">Jelena Lazic</name><affiliation><nlm:aff id="aff30">University Children`s Hospital, Belgrade, Serbia</nlm:aff></affiliation></author><author><name sortKey="Manabe, Atsushi" sort="Manabe, Atsushi" uniqKey="Manabe A" first="Atsushi" last="Manabe">Atsushi Manabe</name><affiliation><nlm:aff id="aff31">Hokkaido University in Sapporo, Japan</nlm:aff></affiliation></author><author><name sortKey="Styczynski, Jan" sort="Styczynski, Jan" uniqKey="Styczynski J" first="Jan" last="Styczynski">Jan Styczynski</name><affiliation><nlm:aff id="aff32">Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University, Bydgoszcz, Poland</nlm:aff></affiliation></author><author><name sortKey="Kovacs, Gabor" sort="Kovacs, Gabor" uniqKey="Kovacs G" first="Gabor" last="Kovacs">Gabor Kovacs</name><affiliation><nlm:aff id="aff33">2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary</nlm:aff></affiliation></author><author><name sortKey="Ottoffy, Gabor" sort="Ottoffy, Gabor" uniqKey="Ottoffy G" first="Gabor" last="Ottoffy">Gabor Ottoffy</name><affiliation><nlm:aff id="aff34">Oncohematology Unit, Dep. of Ped., University of Pécs, Hungary</nlm:aff></affiliation></author><author><name sortKey="Felice, Marisa" sort="Felice, Marisa" uniqKey="Felice M" first="Marisa" last="Felice">Marisa Felice</name><affiliation><nlm:aff id="aff35">Hospital de Pediatría, "Prof. Dr. Juan P. Garrahan", Argentina</nlm:aff></affiliation></author><author><name sortKey="Buldini, Barbara" sort="Buldini, Barbara" uniqKey="Buldini B" first="Barbara" last="Buldini">Barbara Buldini</name><affiliation><nlm:aff id="aff36">Onco Hematology Unit, Dept. Salute della Donna e del Bambino, Università degli Studi di Padova, Italy</nlm:aff></affiliation></author><author><name sortKey="Conter, Valentino" sort="Conter, Valentino" uniqKey="Conter V" first="Valentino" last="Conter">Valentino Conter</name><affiliation><nlm:aff id="aff4">Clinica Pediatrica Universita degli Studi di Milano Bicocca, Monza, Italy</nlm:aff></affiliation></author><author><name sortKey="Stary, Jan" sort="Stary, Jan" uniqKey="Stary J" first="Jan" last="Stary">Jan Stary</name><affiliation><nlm:aff id="aff2">Department of Pediatric Hematology, Charles University and Univ. Hospital Motol, Prague, Czechia</nlm:aff></affiliation></author><author><name sortKey="Schrappe, Martin" sort="Schrappe, Martin" uniqKey="Schrappe M" first="Martin" last="Schrappe">Martin Schrappe</name><affiliation><nlm:aff id="aff37">Childrens Hospital Medical Center Schleswig-Holstein, Kiel, Germany</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7141482</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141482</idno><idno type="RBID">PMC:7141482</idno><idno type="doi">10.1016/j.ejca.2020.03.021</idno><idno type="pmid">NONE</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000F90</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F90</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Flash Survey on SARS-CoV-2 Infections in Pediatric Patients on anti-Cancer Treatment</title><author><name sortKey="Hrusak, Ondrej" sort="Hrusak, Ondrej" uniqKey="Hrusak O" first="Ondrej" last="Hrusak">Ondrej Hrusak</name><affiliation><nlm:aff id="aff1">CLIP - Childhood Leukemia Investigation Prague</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Pediatric Hematology, Charles University and Univ. Hospital Motol, Prague, Czechia</nlm:aff></affiliation></author><author><name sortKey="Kalina, Tomas" sort="Kalina, Tomas" uniqKey="Kalina T" first="Tomas" last="Kalina">Tomas Kalina</name><affiliation><nlm:aff id="aff1">CLIP - Childhood Leukemia Investigation Prague</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Department of Pediatric Hematology, Charles University and Univ. Hospital Motol, Prague, Czechia</nlm:aff></affiliation></author><author><name sortKey="Wolf, Joshua" sort="Wolf, Joshua" uniqKey="Wolf J" first="Joshua" last="Wolf">Joshua Wolf</name><affiliation><nlm:aff id="aff3">Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, USA</nlm:aff></affiliation></author><author><name sortKey="Balduzzi, Adriana" sort="Balduzzi, Adriana" uniqKey="Balduzzi A" first="Adriana" last="Balduzzi">Adriana Balduzzi</name><affiliation><nlm:aff id="aff4">Clinica Pediatrica Universita degli Studi di Milano Bicocca, Monza, Italy</nlm:aff></affiliation></author><author><name sortKey="Provenzi, Massimo" sort="Provenzi, Massimo" uniqKey="Provenzi M" first="Massimo" last="Provenzi">Massimo Provenzi</name><affiliation><nlm:aff id="aff5">Oncologia Pediatrica, Ospedale Papa Giovanni XXIII, Bergamo, Italy</nlm:aff></affiliation></author><author><name sortKey="Rizzari, Carmelo" sort="Rizzari, Carmelo" uniqKey="Rizzari C" first="Carmelo" last="Rizzari">Carmelo Rizzari</name><affiliation><nlm:aff id="aff6">Pediatric Hematology Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, ASST Monza</nlm:aff></affiliation></author><author><name sortKey="Rives, Susana" sort="Rives, Susana" uniqKey="Rives S" first="Susana" last="Rives">Susana Rives</name><affiliation><nlm:aff id="aff7">Hospital Sant Joan de Déu de Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Del Pozo Carlavilla, Maria" sort="Del Pozo Carlavilla, Maria" uniqKey="Del Pozo Carlavilla M" first="María" last="Del Pozo Carlavilla">María Del Pozo Carlavilla</name><affiliation><nlm:aff id="aff8">Hospital General Universitario de Albacete, Spain</nlm:aff></affiliation></author><author><name sortKey="Valerio Alonso, Maria Eli" sort="Valerio Alonso, Maria Eli" uniqKey="Valerio Alonso M" first="Maria Eli" last="Valerio Alonso">Maria Eli Valerio Alonso</name><affiliation><nlm:aff id="aff8">Hospital General Universitario de Albacete, Spain</nlm:aff></affiliation></author><author><name sortKey="Dominguez Pinilla, Nerea" sort="Dominguez Pinilla, Nerea" uniqKey="Dominguez Pinilla N" first="Nerea" last="Domínguez Pinilla">Nerea Domínguez Pinilla</name><affiliation><nlm:aff id="aff9">Hospital Virgen de la Salud, Spain</nlm:aff></affiliation></author><author><name sortKey="Bourquin, Jean Pierre" sort="Bourquin, Jean Pierre" uniqKey="Bourquin J" first="Jean-Pierre" last="Bourquin">Jean-Pierre Bourquin</name><affiliation><nlm:aff id="aff10">Department of Oncology and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland</nlm:aff></affiliation></author><author><name sortKey="Schmiegelow, Kjeld" sort="Schmiegelow, Kjeld" uniqKey="Schmiegelow K" first="Kjeld" last="Schmiegelow">Kjeld Schmiegelow</name><affiliation><nlm:aff id="aff11">Department of Peadiatrics and Adolescent Medicine, Rigshospitalet University Hospital, Copenhagen, Denmark</nlm:aff></affiliation></author><author><name sortKey="Attarbaschi, Andishe" sort="Attarbaschi, Andishe" uniqKey="Attarbaschi A" first="Andishe" last="Attarbaschi">Andishe Attarbaschi</name><affiliation><nlm:aff id="aff12">Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria</nlm:aff></affiliation></author><author><name sortKey="Grillner, Pernilla" sort="Grillner, Pernilla" uniqKey="Grillner P" first="Pernilla" last="Grillner">Pernilla Grillner</name><affiliation><nlm:aff id="aff13">Pediatric Oncology, Karolinska University Hospital, Sweden</nlm:aff></affiliation></author><author><name sortKey="Mellgren, Karin" sort="Mellgren, Karin" uniqKey="Mellgren K" first="Karin" last="Mellgren">Karin Mellgren</name><affiliation><nlm:aff id="aff14">Department of Pediatric Haematology and Oncology, Sahlgrenska University Hospital, Gothenberg, Sweden</nlm:aff></affiliation></author><author><name sortKey="Ten Bosch Van Der Werff, J" sort="Ten Bosch Van Der Werff, J" uniqKey="Ten Bosch Van Der Werff J" first="J." last="Ten Bosch Van Der Werff">J. Ten Bosch Van Der Werff</name><affiliation><nlm:aff id="aff15">UZ Brussels, Belgium</nlm:aff></affiliation></author><author><name sortKey="Pieters, Rob" sort="Pieters, Rob" uniqKey="Pieters R" first="Rob" last="Pieters">Rob Pieters</name><affiliation><nlm:aff id="aff16">Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Brozou, Triantafyllia" sort="Brozou, Triantafyllia" uniqKey="Brozou T" first="Triantafyllia" last="Brozou">Triantafyllia Brozou</name><affiliation><nlm:aff id="aff17">Department of Pediatric Oncology Hematology and Clinical Immunology Heinrich Heine University Dusseldorf</nlm:aff></affiliation></author><author><name sortKey="Borkhardt, Arndt" sort="Borkhardt, Arndt" uniqKey="Borkhardt A" first="Arndt" last="Borkhardt">Arndt Borkhardt</name><affiliation><nlm:aff id="aff17">Department of Pediatric Oncology Hematology and Clinical Immunology Heinrich Heine University Dusseldorf</nlm:aff></affiliation></author><author><name sortKey="Escherich, Gabriele" sort="Escherich, Gabriele" uniqKey="Escherich G" first="Gabriele" last="Escherich">Gabriele Escherich</name><affiliation><nlm:aff id="aff18">Klinik für Pädiatrische Hämatologie und Onkologie Universtitätsklinikum Eppendorf, Hamburg, Germany</nlm:aff></affiliation></author><author><name sortKey="Lauten, Melchior" sort="Lauten, Melchior" uniqKey="Lauten M" first="Melchior" last="Lauten">Melchior Lauten</name><affiliation><nlm:aff id="aff19">University Hospital Schleswig-Holstein, Campus Lübeck, Germany</nlm:aff></affiliation></author><author><name sortKey="Stanulla, Martin" sort="Stanulla, Martin" uniqKey="Stanulla M" first="Martin" last="Stanulla">Martin Stanulla</name><affiliation><nlm:aff id="aff20">Department of Pediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany</nlm:aff></affiliation></author><author><name sortKey="Smith, Owen" sort="Smith, Owen" uniqKey="Smith O" first="Owen" last="Smith">Owen Smith</name><affiliation><nlm:aff id="aff21">National Children’s Cancer Service, Children’s Health Ireland at Crumlin, Dublin, Ireland</nlm:aff></affiliation></author><author><name sortKey="Juh Yeoh, Allen Eng" sort="Juh Yeoh, Allen Eng" uniqKey="Juh Yeoh A" first="Allen Eng" last="Juh Yeoh">Allen Eng Juh Yeoh</name><affiliation><nlm:aff id="aff22">Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore</nlm:aff></affiliation></author><author><name sortKey="Elitzur, Sarah" sort="Elitzur, Sarah" uniqKey="Elitzur S" first="Sarah" last="Elitzur">Sarah Elitzur</name><affiliation><nlm:aff id="aff23">Schneider Children's Medical Center of Israel</nlm:aff></affiliation></author><author><name sortKey="Vora, Ajay" sort="Vora, Ajay" uniqKey="Vora A" first="Ajay" last="Vora">Ajay Vora</name><affiliation><nlm:aff id="aff24">Great Ormond Street Hospital, London, UK</nlm:aff></affiliation></author><author><name sortKey="Li, Chi Kong" sort="Li, Chi Kong" uniqKey="Li C" first="Chi-Kong" last="Li">Chi-Kong Li</name><affiliation><nlm:aff id="aff25">Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Ariffin, Hany" sort="Ariffin, Hany" uniqKey="Ariffin H" first="Hany" last="Ariffin">Hany Ariffin</name><affiliation><nlm:aff id="aff26">University of Malaya Medical Centre, Kuala Lumpur, Malaysia</nlm:aff></affiliation></author><author><name sortKey="Kolenova, Alexandra" sort="Kolenova, Alexandra" uniqKey="Kolenova A" first="Alexandra" last="Kolenova">Alexandra Kolenova</name><affiliation><nlm:aff id="aff27">Department of Pediatric Hematology and Oncology, Comenius University, Bratislava, Slovakia</nlm:aff></affiliation></author><author><name sortKey="Dallapozza, Luciano" sort="Dallapozza, Luciano" uniqKey="Dallapozza L" first="Luciano" last="Dallapozza">Luciano Dallapozza</name><affiliation><nlm:aff id="aff28">The Cancer Centre for Children, The Children's Hospital at Westmead, Australia</nlm:aff></affiliation></author><author><name sortKey="Farah, Roula" sort="Farah, Roula" uniqKey="Farah R" first="Roula" last="Farah">Roula Farah</name><affiliation><nlm:aff id="aff29">LAUMC-Rizk Hospital, Beirut, Lebanon</nlm:aff></affiliation></author><author><name sortKey="Lazic, Jelena" sort="Lazic, Jelena" uniqKey="Lazic J" first="Jelena" last="Lazic">Jelena Lazic</name><affiliation><nlm:aff id="aff30">University Children`s Hospital, Belgrade, Serbia</nlm:aff></affiliation></author><author><name sortKey="Manabe, Atsushi" sort="Manabe, Atsushi" uniqKey="Manabe A" first="Atsushi" last="Manabe">Atsushi Manabe</name><affiliation><nlm:aff id="aff31">Hokkaido University in Sapporo, Japan</nlm:aff></affiliation></author><author><name sortKey="Styczynski, Jan" sort="Styczynski, Jan" uniqKey="Styczynski J" first="Jan" last="Styczynski">Jan Styczynski</name><affiliation><nlm:aff id="aff32">Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University, Bydgoszcz, Poland</nlm:aff></affiliation></author><author><name sortKey="Kovacs, Gabor" sort="Kovacs, Gabor" uniqKey="Kovacs G" first="Gabor" last="Kovacs">Gabor Kovacs</name><affiliation><nlm:aff id="aff33">2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary</nlm:aff></affiliation></author><author><name sortKey="Ottoffy, Gabor" sort="Ottoffy, Gabor" uniqKey="Ottoffy G" first="Gabor" last="Ottoffy">Gabor Ottoffy</name><affiliation><nlm:aff id="aff34">Oncohematology Unit, Dep. of Ped., University of Pécs, Hungary</nlm:aff></affiliation></author><author><name sortKey="Felice, Marisa" sort="Felice, Marisa" uniqKey="Felice M" first="Marisa" last="Felice">Marisa Felice</name><affiliation><nlm:aff id="aff35">Hospital de Pediatría, "Prof. Dr. Juan P. Garrahan", Argentina</nlm:aff></affiliation></author><author><name sortKey="Buldini, Barbara" sort="Buldini, Barbara" uniqKey="Buldini B" first="Barbara" last="Buldini">Barbara Buldini</name><affiliation><nlm:aff id="aff36">Onco Hematology Unit, Dept. Salute della Donna e del Bambino, Università degli Studi di Padova, Italy</nlm:aff></affiliation></author><author><name sortKey="Conter, Valentino" sort="Conter, Valentino" uniqKey="Conter V" first="Valentino" last="Conter">Valentino Conter</name><affiliation><nlm:aff id="aff4">Clinica Pediatrica Universita degli Studi di Milano Bicocca, Monza, Italy</nlm:aff></affiliation></author><author><name sortKey="Stary, Jan" sort="Stary, Jan" uniqKey="Stary J" first="Jan" last="Stary">Jan Stary</name><affiliation><nlm:aff id="aff2">Department of Pediatric Hematology, Charles University and Univ. Hospital Motol, Prague, Czechia</nlm:aff></affiliation></author><author><name sortKey="Schrappe, Martin" sort="Schrappe, Martin" uniqKey="Schrappe M" first="Martin" last="Schrappe">Martin Schrappe</name><affiliation><nlm:aff id="aff37">Childrens Hospital Medical Center Schleswig-Holstein, Kiel, Germany</nlm:aff></affiliation></author></analytic><series><title level="j">European Journal of Cancer</title><idno type="ISSN">0959-8049</idno><idno type="eISSN">1879-0852</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Since the beginning of COVID-19 pandemics, it is known that the severe course of the disease occurs mostly among elderly, whereas it is rare among children and young adults. Comorbidities, in particular diabetes and hypertension, clearly associated with age, besides obesity and smoke are strongly associated with the need of intensive treatment and a dismal outcome. A weaker immunity of the elderly has been proposed as a possible explanation of this uneven age distribution. Along the same line, anecdotal information from Wuhan, China mentioned a severe course of COVID-19 in a child treated for leukemia.</p></sec><sec><title>Aim and methods</title><p>We made a flash survey on COVID19 incidence and severity among children on anticancer treatment. Respondents were asked by email to fill in a short web based survey.</p></sec><sec><title>Results</title><p>We received reports from 25 countries, where approximately 10,000 patients at risk are followed. At the time of the survey, over 200 of these children were tested, nine of whom were positive for COVID-19. Eight of the nine cases had asymptomatic to mild disease and one was just diagnosed with COVID-19. We also discuss preventive measures that are in place or should be taken as well as treatment options in immunocompromised children with COVID-19.</p></sec><sec><title>Conclusion</title><p>Thus, even children receiving anti-cancer chemotherapy may have a mild or asymptomatic course of COVID-19. While we should not underestimate the risk of developing a more severe course of COVID-19 than observed here, the intensity of preventive measures should not cause delays or obstructions in oncological treatment.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Wu, Z" uniqKey="Wu Z">Z. Wu</name></author><author><name sortKey="Mcgoogan, J M" uniqKey="Mcgoogan J">J.M. McGoogan</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lu, X" uniqKey="Lu X">X. Lu</name></author><author><name sortKey="Zhang, L" uniqKey="Zhang L">L. Zhang</name></author><author><name sortKey="Du, H" uniqKey="Du H">H. Du</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wei, M" uniqKey="Wei M">M. Wei</name></author><author><name sortKey="Yuan, J" uniqKey="Yuan J">J. Yuan</name></author><author><name sortKey="Liu, Y" uniqKey="Liu Y">Y. Liu</name></author><author><name sortKey="Fu, T" uniqKey="Fu T">T. Fu</name></author><author><name sortKey="Yu, X" uniqKey="Yu X">X. Yu</name></author><author><name sortKey="Zhang, Z J" uniqKey="Zhang Z">Z.-J. Zhang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Liu, W" uniqKey="Liu W">W. Liu</name></author><author><name sortKey="Zhang, Q" uniqKey="Zhang Q">Q. Zhang</name></author><author><name sortKey="Chen, J" uniqKey="Chen J">J. Chen</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chen, Z" uniqKey="Chen Z">Z. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Eur J Cancer</journal-id><journal-id journal-id-type="iso-abbrev">Eur. J. Cancer</journal-id><journal-title-group><journal-title>European Journal of Cancer</journal-title></journal-title-group><issn pub-type="ppub">0959-8049</issn><issn pub-type="epub">1879-0852</issn><publisher><publisher-name>Published by Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7141482</article-id><article-id pub-id-type="publisher-id">S0959-8049(20)30162-3</article-id><article-id pub-id-type="doi">10.1016/j.ejca.2020.03.021</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Flash Survey on SARS-CoV-2 Infections in Pediatric Patients on anti-Cancer Treatment</article-title></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Hrusak</surname><given-names>Ondrej</given-names></name><email>Ondrej.Hrusak@gmail.com</email><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref><xref rid="cor1" ref-type="corresp">∗</xref></contrib><contrib contrib-type="author" id="au2"><name><surname>Kalina</surname><given-names>Tomas</given-names></name><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au3"><name><surname>Wolf</surname><given-names>Joshua</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au4"><name><surname>Balduzzi</surname><given-names>Adriana</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="au5"><name><surname>Provenzi</surname><given-names>Massimo</given-names></name><xref rid="aff5" ref-type="aff">e</xref></contrib><contrib contrib-type="author" id="au6"><name><surname>Rizzari</surname><given-names>Carmelo</given-names></name><xref rid="aff6" ref-type="aff">f</xref></contrib><contrib contrib-type="author" id="au7"><name><surname>Rives</surname><given-names>Susana</given-names></name><xref rid="aff7" ref-type="aff">g</xref></contrib><contrib contrib-type="author" id="au8"><name><surname>del Pozo Carlavilla</surname><given-names>María</given-names></name><xref rid="aff8" ref-type="aff">h</xref></contrib><contrib contrib-type="author" id="au9"><name><surname>Valerio Alonso</surname><given-names>Maria Eli</given-names></name><xref rid="aff8" ref-type="aff">h</xref></contrib><contrib contrib-type="author" id="au10"><name><surname>Domínguez Pinilla</surname><given-names>Nerea</given-names></name><xref rid="aff9" ref-type="aff">i</xref></contrib><contrib contrib-type="author" id="au11"><name><surname>Bourquin</surname><given-names>Jean-Pierre</given-names></name><xref rid="aff10" ref-type="aff">j</xref></contrib><contrib contrib-type="author" id="au12"><name><surname>Schmiegelow</surname><given-names>Kjeld</given-names></name><xref rid="aff11" ref-type="aff">k</xref></contrib><contrib contrib-type="author" id="au13"><name><surname>Attarbaschi</surname><given-names>Andishe</given-names></name><xref rid="aff12" ref-type="aff">l</xref></contrib><contrib contrib-type="author" id="au14"><name><surname>Grillner</surname><given-names>Pernilla</given-names></name><xref rid="aff13" ref-type="aff">m</xref></contrib><contrib contrib-type="author" id="au15"><name><surname>Mellgren</surname><given-names>Karin</given-names></name><xref rid="aff14" ref-type="aff">n</xref></contrib><contrib contrib-type="author" id="au16"><name><surname>Ten Bosch van der Werff</surname><given-names>J.</given-names></name><xref rid="aff15" ref-type="aff">o</xref></contrib><contrib contrib-type="author" id="au17"><name><surname>Pieters</surname><given-names>Rob</given-names></name><xref rid="aff16" ref-type="aff">p</xref></contrib><contrib contrib-type="author" id="au18"><name><surname>Brozou</surname><given-names>Triantafyllia</given-names></name><xref rid="aff17" ref-type="aff">q</xref></contrib><contrib contrib-type="author" id="au19"><name><surname>Borkhardt</surname><given-names>Arndt</given-names></name><xref rid="aff17" ref-type="aff">q</xref></contrib><contrib contrib-type="author" id="au20"><name><surname>Escherich</surname><given-names>Gabriele</given-names></name><xref rid="aff18" ref-type="aff">r</xref></contrib><contrib contrib-type="author" id="au21"><name><surname>Lauten</surname><given-names>Melchior</given-names></name><xref rid="aff19" ref-type="aff">s</xref></contrib><contrib contrib-type="author" id="au22"><name><surname>Stanulla</surname><given-names>Martin</given-names></name><xref rid="aff20" ref-type="aff">t</xref></contrib><contrib contrib-type="author" id="au23"><name><surname>Smith</surname><given-names>Owen</given-names></name><xref rid="aff21" ref-type="aff">u</xref></contrib><contrib contrib-type="author" id="au24"><name><surname>Juh Yeoh</surname><given-names>Allen Eng</given-names></name><xref rid="aff22" ref-type="aff">v</xref></contrib><contrib contrib-type="author" id="au25"><name><surname>Elitzur</surname><given-names>Sarah</given-names></name><xref rid="aff23" ref-type="aff">w</xref></contrib><contrib contrib-type="author" id="au26"><name><surname>Vora</surname><given-names>Ajay</given-names></name><xref rid="aff24" ref-type="aff">x</xref></contrib><contrib contrib-type="author" id="au27"><name><surname>Li</surname><given-names>Chi-Kong</given-names></name><xref rid="aff25" ref-type="aff">y</xref></contrib><contrib contrib-type="author" id="au28"><name><surname>Ariffin</surname><given-names>Hany</given-names></name><xref rid="aff26" ref-type="aff">z</xref></contrib><contrib contrib-type="author" id="au29"><name><surname>Kolenova</surname><given-names>Alexandra</given-names></name><xref rid="aff27" ref-type="aff">aa</xref></contrib><contrib contrib-type="author" id="au30"><name><surname>Dallapozza</surname><given-names>Luciano</given-names></name><xref rid="aff28" ref-type="aff">ab</xref></contrib><contrib contrib-type="author" id="au31"><name><surname>Farah</surname><given-names>Roula</given-names></name><xref rid="aff29" ref-type="aff">ac</xref></contrib><contrib contrib-type="author" id="au32"><name><surname>Lazic</surname><given-names>Jelena</given-names></name><xref rid="aff30" ref-type="aff">ad</xref></contrib><contrib contrib-type="author" id="au33"><name><surname>Manabe</surname><given-names>Atsushi</given-names></name><xref rid="aff31" ref-type="aff">ae</xref></contrib><contrib contrib-type="author" id="au34"><name><surname>Styczynski</surname><given-names>Jan</given-names></name><xref rid="aff32" ref-type="aff">af</xref></contrib><contrib contrib-type="author" id="au35"><name><surname>Kovacs</surname><given-names>Gabor</given-names></name><xref rid="aff33" ref-type="aff">ag</xref></contrib><contrib contrib-type="author" id="au36"><name><surname>Ottoffy</surname><given-names>Gabor</given-names></name><xref rid="aff34" ref-type="aff">ah</xref></contrib><contrib contrib-type="author" id="au37"><name><surname>Felice</surname><given-names>Marisa</given-names></name><xref rid="aff35" ref-type="aff">ai</xref></contrib><contrib contrib-type="author" id="au38"><name><surname>Buldini</surname><given-names>Barbara</given-names></name><xref rid="aff36" ref-type="aff">aj</xref></contrib><contrib contrib-type="author" id="au39"><name><surname>Conter</surname><given-names>Valentino</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="au40"><name><surname>Stary</surname><given-names>Jan</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au41"><name><surname>Schrappe</surname><given-names>Martin</given-names></name><xref rid="aff37" ref-type="aff">ak</xref></contrib></contrib-group><aff id="aff1"><label>a</label>CLIP - Childhood Leukemia Investigation Prague</aff><aff id="aff2"><label>b</label>Department of Pediatric Hematology, Charles University and Univ. Hospital Motol, Prague, Czechia</aff><aff id="aff3"><label>c</label>Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, USA</aff><aff id="aff4"><label>d</label>Clinica Pediatrica Universita degli Studi di Milano Bicocca, Monza, Italy</aff><aff id="aff5"><label>e</label>Oncologia Pediatrica, Ospedale Papa Giovanni XXIII, Bergamo, Italy</aff><aff id="aff6"><label>f</label>Pediatric Hematology Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, ASST Monza</aff><aff id="aff7"><label>g</label>Hospital Sant Joan de Déu de Barcelona, Spain</aff><aff id="aff8"><label>h</label>Hospital General Universitario de Albacete, Spain</aff><aff id="aff9"><label>i</label>Hospital Virgen de la Salud, Spain</aff><aff id="aff10"><label>j</label>Department of Oncology and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland</aff><aff id="aff11"><label>k</label>Department of Peadiatrics and Adolescent Medicine, Rigshospitalet University Hospital, Copenhagen, Denmark</aff><aff id="aff12"><label>l</label>Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria</aff><aff id="aff13"><label>m</label>Pediatric Oncology, Karolinska University Hospital, Sweden</aff><aff id="aff14"><label>n</label>Department of Pediatric Haematology and Oncology, Sahlgrenska University Hospital, Gothenberg, Sweden</aff><aff id="aff15"><label>o</label>UZ Brussels, Belgium</aff><aff id="aff16"><label>p</label>Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands</aff><aff id="aff17"><label>q</label>Department of Pediatric Oncology Hematology and Clinical Immunology Heinrich Heine University Dusseldorf</aff><aff id="aff18"><label>r</label>Klinik für Pädiatrische Hämatologie und Onkologie Universtitätsklinikum Eppendorf, Hamburg, Germany</aff><aff id="aff19"><label>s</label>University Hospital Schleswig-Holstein, Campus Lübeck, Germany</aff><aff id="aff20"><label>t</label>Department of Pediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany</aff><aff id="aff21"><label>u</label>National Children’s Cancer Service, Children’s Health Ireland at Crumlin, Dublin, Ireland</aff><aff id="aff22"><label>v</label>Yong Loo Lin School of Medicine and Cancer Science Institute, National University of Singapore, and Viva-University Children's Cancer Centre, National University Hospital, Singapore</aff><aff id="aff23"><label>w</label>Schneider Children's Medical Center of Israel</aff><aff id="aff24"><label>x</label>Great Ormond Street Hospital, London, UK</aff><aff id="aff25"><label>y</label>Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong</aff><aff id="aff26"><label>z</label>University of Malaya Medical Centre, Kuala Lumpur, Malaysia</aff><aff id="aff27"><label>aa</label>Department of Pediatric Hematology and Oncology, Comenius University, Bratislava, Slovakia</aff><aff id="aff28"><label>ab</label>The Cancer Centre for Children, The Children's Hospital at Westmead, Australia</aff><aff id="aff29"><label>ac</label>LAUMC-Rizk Hospital, Beirut, Lebanon</aff><aff id="aff30"><label>ad</label>University Children`s Hospital, Belgrade, Serbia</aff><aff id="aff31"><label>ae</label>Hokkaido University in Sapporo, Japan</aff><aff id="aff32"><label>af</label>Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University, Bydgoszcz, Poland</aff><aff id="aff33"><label>ag</label>2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary</aff><aff id="aff34"><label>ah</label>Oncohematology Unit, Dep. of Ped., University of Pécs, Hungary</aff><aff id="aff35"><label>ai</label>Hospital de Pediatría, "Prof. Dr. Juan P. Garrahan", Argentina</aff><aff id="aff36"><label>aj</label>Onco Hematology Unit, Dept. Salute della Donna e del Bambino, Università degli Studi di Padova, Italy</aff><aff id="aff37"><label>ak</label>Childrens Hospital Medical Center Schleswig-Holstein, Kiel, Germany</aff><author-notes><corresp id="cor1"><label>∗</label><italic>Corresponding author</italic>. CLIP - Childhood Leukemia Investigation Prague. <email>Ondrej.Hrusak@gmail.com</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>7</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>7</day><month>4</month><year>2020</year></pub-date><history><date date-type="received"><day>27</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>28</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Published by Elsevier Ltd.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0010"><sec><title>Introduction</title><p>Since the beginning of COVID-19 pandemics, it is known that the severe course of the disease occurs mostly among elderly, whereas it is rare among children and young adults. Comorbidities, in particular diabetes and hypertension, clearly associated with age, besides obesity and smoke are strongly associated with the need of intensive treatment and a dismal outcome. A weaker immunity of the elderly has been proposed as a possible explanation of this uneven age distribution. Along the same line, anecdotal information from Wuhan, China mentioned a severe course of COVID-19 in a child treated for leukemia.</p></sec><sec><title>Aim and methods</title><p>We made a flash survey on COVID19 incidence and severity among children on anticancer treatment. Respondents were asked by email to fill in a short web based survey.</p></sec><sec><title>Results</title><p>We received reports from 25 countries, where approximately 10,000 patients at risk are followed. At the time of the survey, over 200 of these children were tested, nine of whom were positive for COVID-19. Eight of the nine cases had asymptomatic to mild disease and one was just diagnosed with COVID-19. We also discuss preventive measures that are in place or should be taken as well as treatment options in immunocompromised children with COVID-19.</p></sec><sec><title>Conclusion</title><p>Thus, even children receiving anti-cancer chemotherapy may have a mild or asymptomatic course of COVID-19. While we should not underestimate the risk of developing a more severe course of COVID-19 than observed here, the intensity of preventive measures should not cause delays or obstructions in oncological treatment.</p></sec></abstract><abstract abstract-type="author-highlights" id="abs0015"><title>Highlights</title><p><list list-type="simple" id="ulist0010"><list-item id="u0010"><label>•</label><p id="p0010">Flash survey was used to get data on COVID-19 incidence and severity.</p></list-item><list-item id="u0015"><label>•</label><p id="p0015">Pediatric Hem/Onc departments of 25 countries responded.</p></list-item><list-item id="u0020"><label>•</label><p id="p0020">COVID-19 may have a mild course in these immunocompromised children.</p></list-item><list-item id="u0025"><label>•</label><p id="p0025">Precautions should be taken to prevent any infections including COVID-19.</p></list-item><list-item id="u0030"><label>•</label><p id="p0030">Malignancy is a primary danger; preventive measures should not hinder its treatment.</p></list-item></list></p></abstract><kwd-group id="kwrds0010"><title>Keywords</title><kwd>COVID-19</kwd><kwd>anti-cancer chemotherapy</kwd><kwd>immunosuppression</kwd><kwd>children</kwd></kwd-group></article-meta></front><body><sec id="sec1"><title>Introduction</title><p id="p0035">The outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) causing the Coronavirus Disease (COVID-19) pandemic in 2020 was identified in December, 2019. By March 17, 2020 it has affected 200,000 cases in 163 countries and in several foci the numbers rise exponentially [World Health Organization, “Rolling updates on coronavirus disease (COVID-19)” <ext-link ext-link-type="uri" xlink:href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen" id="intref0010">https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen</ext-link>]. In spite of high mortality rate, the spectrum of COVID-19 includes asymptomatic infection, upper respiratory tract infection, lower respiratory tract infection through severe respiratory failure, as well as other problems such as myocarditis, sepsis<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref>, and diarrhea (Pan et al, Am. J. Gastroenterol., In Press). The age distribution of the more severe course of the disease is strikingly skewed towards older patients, especially those over 65 years of age<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref><sup>,</sup><xref rid="bib2" ref-type="bibr"><sup>2</sup></xref>. In contrast, pediatric patients rarely develop critical illness.<xref rid="bib3" ref-type="bibr">3</xref>, <xref rid="bib4" ref-type="bibr">4</xref>, <xref rid="bib5" ref-type="bibr">5</xref>, <xref rid="bib6" ref-type="bibr">6</xref>, <xref rid="bib7" ref-type="bibr">7</xref> In one study, only 5% and 0.6% of 2141 evaluable children with confirmed COVID-19 had severe or critical illness respectively.<xref rid="bib7" ref-type="bibr"><sup>7</sup></xref> The biology underlying this disparity in severity is unknown.</p><p id="p0040">The possibility that more severe disease associated with immunosenescence, along with an increased risk of severe disease in adults with cancer, and a single case report of a critically ill child who developed COVID-19 during myelosuppressive chemotherapy, has raised the concern that COVID-19 among immunosuppressed children might be a much more severe illness than is seen in otherwise healthy children.<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref><sup>,</sup><xref rid="bib8" ref-type="bibr">8</xref>, <xref rid="bib9" ref-type="bibr">9</xref>, <xref rid="bib10" ref-type="bibr">10</xref> This is consistent with data for other coronaviruses, which do cause more severe infections in immunocompromised children.<xref rid="bib11" ref-type="bibr"><sup>11</sup></xref> To evaluate this, we used a flash survey to determine whether there was current evidence that pediatric patients with cancer in SARS-CoV-2 affected areas had been tested for this virus or had developed severe COVID-19 disease.</p></sec><sec id="sec2"><title>Results</title><p id="p0045">On March 16, 2020, we circulated a simple survey on COVID-19 incidence and diagnostic and preventative measures. A web-based form was sent by email to 89 addressees, who work in pediatric hematology/oncology (PH/O) departments in many countries. Data was collected one day later. In total, 32 centers or countries provided data on COVID-19 incidence in children treated with chemotherapy or intensive immunosuppression in their institutions or countrywide (<xref rid="tbl1" ref-type="table">Table 1</xref>). The results are shown together with the COVID-19 incidences in general population.<table-wrap position="float" id="tbl1"><label>Table 1</label><caption><p>Flash survey results.</p></caption><alt-text id="alttext0010">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th>Investigator</th><th>Name of institution</th><th>Countrywide incidence of COVID-19 per million</th><th>Number of pts. on chemotherapy</th><th>tested for COVID-19</th><th>proven COVID-19 Total</th></tr></thead><tbody><tr><td rowspan="3">C.R., B.B., A.Bal.</td><td>PH/O Unit, University of Milano-Bicocca, MBBM Foundation, ASST Monza, Italy</td><td rowspan="3">463</td><td>100</td><td>2</td><td>0</td></tr><tr><td>PH/O, Università degli Studi di Padova, Italy</td><td>150</td><td>88</td><td>0</td></tr><tr><td>Italy (entire country)</td><td>1500 - 2000</td><td>not known</td><td>4 (cases 1-4)</td></tr><tr><td>J-P.B.</td><td>Kinderspital Zürich, Switzerland</td><td>317</td><td>100</td><td>1 - 10</td><td>0<xref rid="tbl1fna" ref-type="table-fn">a</xref></td></tr><tr><td>S.R.</td><td>Hospital Sant Joan de Déu de Barcelona, Spain</td><td rowspan="3">244</td><td>250</td><td>0</td><td>0</td></tr><tr><td>N.D.P.</td><td>Hospital Virgen de la Salud, Spain</td><td>35</td><td>3</td><td>1 (case 5)</td></tr><tr><td>M. dP.C., M.E.V.A.</td><td>Hospital General Universitario de Albacete, Spain</td><td>4</td><td>1</td><td>1 (case 6)</td></tr><tr><td rowspan="2">K.S.</td><td>Copenhagen University Hospital, Rigshospitalet, Denmark</td><td rowspan="2">160</td><td>90 - 100</td><td>1 - 10</td><td>0</td></tr><tr><td>Denmark (entire country)</td><td>180</td><td>1 - 10</td><td>0</td></tr><tr><td rowspan="2">A.A.</td><td>St Anna Kinderspital, Vienna, Austria</td><td rowspan="2">148</td><td>100</td><td>1 - 9</td><td>0</td></tr><tr><td>Austria (entire country)</td><td>250</td><td>not known</td><td>0</td></tr><tr><td>P.G.</td><td>PH/O, Karolinska University Hospital, Stockholm, Sweden</td><td rowspan="2">116</td><td>100</td><td>0<xref rid="tbl1fna" ref-type="table-fn">a</xref></td><td>0<xref rid="tbl1fna" ref-type="table-fn">a</xref></td></tr><tr><td>K.M.</td><td>Sahlgrenska University Hospital, Gothenburg, Sweden</td><td>100</td><td>5</td><td>0</td></tr><tr><td>J.T.B.vdW.</td><td>UZ Brussel, Belgium</td><td>107</td><td>10</td><td>0</td><td>0</td></tr><tr><td>A.Bar.</td><td>PH/O, University Hospital Robert Debré, Paris, France</td><td>102</td><td>150</td><td>5</td><td>0</td></tr><tr><td>R.P.</td><td>Princess Maxima Center, Netherlands</td><td>99.5</td><td>900</td><td>5 – 10<xref rid="tbl1fnb" ref-type="table-fn">b</xref></td><td>0</td></tr><tr><td>M.Sch.</td><td>Childrens Hospital Medical Center Schleswig-Holstein, Kiel, Germany</td><td rowspan="5">95.2</td><td>50</td><td>5</td><td>0</td></tr><tr><td>T.B., A.Bo.</td><td>PH/O and Clinical Immunology, Heinrich Heine University Düsseldorf, Germany</td><td>125</td><td>50</td><td>0</td></tr><tr><td>G.E.</td><td>PH/O, Universtitätsklinikum Eppendorf, Germany</td><td>100</td><td>5</td><td>0</td></tr><tr><td>M.L.</td><td>University Hospital Schleswig-Holstein, Campus Lübeck, Germany</td><td>24</td><td>2</td><td>0</td></tr><tr><td>M.St.</td><td>Medizinische Hochschule Hannover, Germany</td><td>100</td><td>5</td><td>0<xref rid="tbl1fna" ref-type="table-fn">a</xref></td></tr><tr><td>O.S.</td><td>National Children’s Cancer Service, Children’s Health Ireland at Crumlin, Dublin, Ireland</td><td>59.1</td><td>not known</td><td>not known</td><td>0</td></tr><tr><td>A.E.J.Y.</td><td>Singapore (entire country)</td><td>45.5</td><td>200</td><td>10</td><td>0</td></tr><tr><td>S.E.</td><td>Schneider Children's Medical Center of Israel</td><td>37.4</td><td>220</td><td>3</td><td>0</td></tr><tr><td>O.H.</td><td>Czechia (entire country)</td><td>37</td><td>250</td><td>2 - 10</td><td>0</td></tr><tr><td>A.V.</td><td>Great Ormond Street Hospital, UK</td><td>22.7</td><td>500</td><td>5</td><td>0</td></tr><tr><td>C.-K.L.</td><td>Hong Kong Children's Hospital</td><td>22.4</td><td>210</td><td>3</td><td>0</td></tr><tr><td rowspan="2">H.A.</td><td>University of Malaya, Kuala Lumpur, Malaysia</td><td rowspan="2">20.8</td><td>100</td><td>1</td><td>0</td></tr><tr><td>Malaysia (entire country)</td><td>500</td><td>1 - 10</td><td>0</td></tr><tr><td>A.K.</td><td>Slovakia (entire country)</td><td>17.8</td><td>180</td><td>3</td><td>0</td></tr><tr><td rowspan="2">L.D.</td><td>The Children's Hospital at Westmead, Australia</td><td rowspan="2">17.7</td><td>300</td><td>0</td><td>0</td></tr><tr><td>Australia (entire country)</td><td>1740</td><td>not known<xref rid="tbl1fnc" ref-type="table-fn">c</xref></td><td>0</td></tr><tr><td>R.F.</td><td>LAU MC-Rizk Hospital,Beirut, Lebanon</td><td>17.6</td><td>20</td><td>1</td><td>0</td></tr><tr><td>J.L.</td><td>University Children's Hospital, Belgrade, Serbia</td><td>8.2</td><td>30</td><td>0</td><td>0</td></tr><tr><td rowspan="2">A.M.</td><td>Hokkaido University in Sapporo, Japan</td><td rowspan="2">6.9</td><td>30</td><td>0</td><td>0</td></tr><tr><td>Japan (entire country)</td><td>2500 - 4000</td><td>not known</td><td>0</td></tr><tr><td>J.Sty.</td><td>Poland (entire country)</td><td>5.8</td><td>1048</td><td>13</td><td>0</td></tr><tr><td>G.O.</td><td>PH/O, University of Pécs, Hungary</td><td rowspan="2">5.2</td><td>7</td><td>0</td><td>0</td></tr><tr><td>G.K.</td><td>Hungary (entire country)</td><td>250</td><td>4</td><td>0</td></tr><tr><td>M.F.</td><td>Hospital de Pediatría, "Prof. Garrahan", Argentina</td><td>1.5</td><td>90 - 100</td><td>1 - 10</td><td>0</td></tr></tbody></table><table-wrap-foot><fn><p>Data reflect a situation as of March 17, 2020.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fna"><label>a</label><p id="ntpara0010">Two positive cases were diagnosed on March 21, 2020 - in Switzerland (case 7) in Stockholm, Sweden (case 8) and in Hannover, Germany (case 9), all are also mentioned in Results.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fnb"><label>b</label><p id="ntpara0015">Additional 80 cases screened by March 19, 2020, all were negative.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fnc"><label>c</label><p id="ntpara0020">As of March 26, 47 to 60 cases were tested in 7 Australian hospitals within ANZCHOG group, all were negative. PH/O = (Department of) Pediatric Hematology/Oncology.</p></fn></table-wrap-foot></table-wrap></p><p id="p0050">Briefly, of more than 200 patients who were tested for SARS-CoV-2 in these PH/O departments, which care for close to 10,000 at-risk patients, only eight cases of proven infection were identified. Given that there is no general recommendation regarding testing of asymptomatic individuals, many centers only tested symptomatic patients, so the true rate of infection is not known. None of the reported cases required intensive care because of COVID-19. Case 1 was a febrile adolescent after mediastinal radiotherapy for osteosarcoma, no information was available regarding prior chemotherapy. Case 2 was a 16year girl with febrile neutropenia after adjuvant chemotherapy for hepatoblastoma. She received azithromycin and granulocyte colony stimulating factor (G-CSF), no pulmonary involvement was present and after 5 days she was free of both neutropenia and fever. Also case 3 had febrile neutropenia, after chemotherapy for a cervical rhabdoid tumor. There were no radiologic signs of pulmonary involvement but she required oxygen for nightly desaturations. She received G-CSF and azithromycin and after 10 days she was dismissed from hospital. Case 4 was a 6-year boy admitted in a hospital for a cisplatin cycle for hepatoblastoma, with a COVID-19-positive swab after the end of therapy; he was discharged without therapy and remained in a good condition. Cases 1-4 were also mentioned elsewhere (Balduzzi et al, submitted). Case 5 was a child with metastatic Ewing sarcoma who developed febrile neutropenia after their 5<sup>th</sup> cycle of chemotherapy. Case 6 was a child with Wilms’ tumor who presented with fever and diarrhea after 6 weeks of chemotherapy; this child did have lymphopenia but not neutropenia. None of these two patients had respiratory symptoms, and both became afebrile within 12-24 hours. Both received hydroxychloroquine, and Case 5 also received Lopinavir-Ritonavir (LPV/r). Two more cases were reported two days after the survey responses were collected. One of them (case 7) was in febrile neutropenia treated for ALL and no data on outcome is available yet. The other one (case 9) was on maintenance treatment for ALL without typical symptoms, tested because his parents were COVID-19-positive; the anti-leukemic maintenance treatment was interrupted until two negative results will be obtained.</p></sec><sec id="sec3"><title>Discussion</title><p id="p0055">To our knowledge, this is the first survey of pediatric oncology centers in SARS-CoV-2 affected areas. We found that the number of infected patients appears to be low, and that the few who were identified had mild and possibly self-limited infection.</p><p id="p0060">The low rate of identified infection is somewhat surprising, as it is reasonable to assume that the pediatric patients with cancer would be at least as susceptible to infection with SARS-CoV-2 infection as their healthy peers. The SARS-CoV-2 does infect children in general, although lower severity of the infection makes children prone to be underreported<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref><sup>,</sup><xref rid="bib6" ref-type="bibr"><sup>6</sup></xref>. Thus, at least in the countries with high COVID-19 incidence, either the transmission of SARS-CoV-2 was prevented by standard infection prevention measures, or cases remained undiagnosed as the course of the infection did not raise a suspicion of COVID-19. In some areas, the devastating overall situation made the diagnostics of mild cases a low priority.</p><p id="p0065">The mild disease experienced by the three children in this study is in direct contrast to the only previously published case of which we are aware. An 8 year old child undergoing myelosuppressive chemotherapy for T-cell acute lymphoblastic leukemia in ALL in a Wuhan hospital developed respiratory failure over the course of 3 weeks, eventually requiring mechanical ventilation; the patient had not recovered at the time of the report<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> (and included in<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref><sup>,</sup><xref rid="bib9" ref-type="bibr"><sup>9</sup></xref>). During the course of that patient’s disease, CRP and IL-6 were only mildly elevated but ferritin levels were high (6417-15,758 ug/L). This is reminiscent of features of hemophagocytic lymphohistiocytosis, which has been previously described to co-occur with infections<xref rid="bib12" ref-type="bibr"><sup>12</sup></xref>. Possible correlation between the severity of infection and the composition and intensity of chemotherapy should be studied in larger cohorts.</p><p id="p0070">The participating countries are gradually strengthening general preventative measures, usually aiming at social distancing, quarantines for the infected and contacts, clean hands and surfaces and cautious checking for possible symptoms – similarly to measures successfully applied in Hong Kong during the SARS epidemic in 2003<xref rid="bib13" ref-type="bibr"><sup>13</sup></xref>.</p><p id="p0075">In PH/O departments, precautions are always taken to protect patients from any infections. The degree of these precautions typically depends on the severity of immunosuppression and differs among hospitals<xref rid="bib14" ref-type="bibr"><sup>14</sup></xref>. Although our study portrays symptomatic COVID-19 as a rare finding among heavily immunocompromised children, at least in the first weeks of pandemics, other viruses do occasionally infect these patients in hospital wards despite these precautions<xref rid="bib15" ref-type="bibr"><sup>15</sup></xref>. The responders to this survey recommend taking additional measures during the COVID-19 epidemic to protect patients and staff from being either infected or in quarantine. As the epidemiological situation develops, only scientifically supported measures should remain in place, not to cause unwanted delays in the treatment of the underlying malignancies.</p><p id="p0080">The overall experience with daily life in hospitals during the peak COVID-19 epidemics has been thoroughly described by Italian physicians (Balduzzi et al, submitted).</p><p id="p0085">There are large differences among countries regarding the specific measures recommended. Most commonly, social contact is being minimized in the general population during high epidemic risk. Whole hospitals or hospital areas in Italy and Spain are designated as “dirty” (suspected or proven SARS-CoV-2 infection) and “clean” (no suspicious symptoms or SARS-CoV-2 test is negative) areas. Facial masks are recommended for all care givers and, if possible, for patients any time during personal contacts. Health professionals taking care of immunocompromised patients are separated into teams without mutual physical contact, to avoid simultaneous infection or preventative quarantine in the entire staff. This can be done by working on alternate days (unless the workload forbids it) or weeks and not sharing offices and common areas. Fewer or no in-person conferences take place. Children with respiratory symptoms are screened for SARS-CoV-2 before entering PH/O units. Outpatient visits for long-term surveillance patients are postponed. Immunosuppressed children are recommended to be isolated from general pediatric patients, where possible. Although these infection prevention measures might reduce the risk of SARS-CoV-2 transmission, they can also directly or indirectly complicate patient care. It can cause a shortage of clinical doctors, nurses, diagnosticians, and technical supportive staff, drug shortages, higher stress in accompanying parents, logistic problems with transfusion and transplant products, and organizational inaccuracies in clinical decision making process due to lack of meetings.</p><p id="p0090">In conclusion, heavily immunocompromised patients in the PH/O wards remain at high potential risk of acquiring infectious diseases, including COVID-19. In a striking contrast, the current number of reported cases of COVID-19 among these patients is limited to a single previously reported case from China plus the four cases reported here. More research is needed to better understand the epidemiology of SARS-CoV-2 infection and COVID-19 in pediatric patients with cancer or other immunocompromised children. More cases are expected as the pandemic is only just unfolding in many countries. This flash survey, although providing a very early picture of COVID-19, shows that the disease may have a mild course even in children receiving anticancer chemotherapy. The risk of severe disease with COVID-19 in profoundly immunocompromised children is still unknown, and predictors of asymptomatic infection, mild disease or severe and life-threatening infection would help support the development of approaches to prevent as well as to optimize treatment of COVID-19 in this vulnerable patient population.</p></sec><sec id="sec4"><title>Funding</title><p id="p0095">none declared.</p></sec><sec sec-type="COI-statement"><title>Declaration of Competing Interest</title><p id="p0100">Authors have no conflict of interest with regard to this study.</p></sec></body><back><ref-list id="cebib0010"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sref1"><person-group person-group-type="author"><name><surname>Wu</surname><given-names>Z.</given-names></name><name><surname>McGoogan</surname><given-names>J.M.</given-names></name></person-group><article-title>Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China</article-title><source>JAMA</source><year>2019</year></element-citation></ref><ref id="bib2"><label>2</label><mixed-citation publication-type="other" id="sref2">Ruan Q, Yang K, Wang W, Jiang L, Song J. 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