COVID-19 in New York City Pediatric Hematology and Oncology Patients

Background: Little is known about the effect of COVID-19 disease on pediatric hematology, oncology and hematopoietic stem cell transplant (HCT) patients. Methods: We identified all patients < 21 years of age tested for COVID-19 infection at Memorial Sloan Kettering Cancer Center (MSK) and the pediatric hematology, oncology and HCT programs at Columbia University Irving Medical Center and Weill Cornell Medical Center, both affiliated with New York Presbyterian Hospital (NYP), from March 10 through April 6, 2020. Demographic, clinical presentation, course and treatment data is presented for patients positive for COVID-19. Findings: 174 patients were tested for COVID-19 at MSK (n=120) and NYP (n = 54); 19 patients tested positive (11%) with more males (n=15) than females (n=4). Of the COVID-19 positive patients, three had non-malignant hematologic diagnoses; 14 had cancer; and two were post-HCT. The most common symptoms on presentation were fever (n=13), cough (n=9), and difficulty breathing (n=7). Of the 14 cancer patients, 9 (64%) experienced treatment delays due to COVID-19 positivity. Eleven patients were hospitalized with 5 requiring intensive care, including one patient with sickle cell disease who died of COVID-19 related complications. Interpretation: The majority of our patients had mild disease and many were managed as outpatients, similar to previous reports of pediatric patients from China and Europe. We observed an apparent higher incidence of infection in males compared to females. Several COVID-19 positive cancer patients had treatment delays, however those who received myelosuppressive chemotherapy during and prior to infection did not appear to have increased complications. Funding Statement: General institutional support from NIH Cancer Center Support Grant P30 CA008748. Declaration of Interests: The authors have no relevant conflicting interests. Ethics Approval Statement: This study was approved by the Institutional Review Boards of MSK, CUIMC and WCMC for retrospective evaluation of pediatric hematology, oncology, and HCT patients who were tested for COVID-19 infection from March 10 through April 6, 2020. Informed consent was waived. All data was de-identified.