COVID-19 Causes Severe Disease, Disrupted Treatment in Children with Cancer


Investigators found that 65% of patients with cancer and COVID-19 were hospitalized and 17% required admission or transfer to a higher level of care.

A large, international research effort has found that 20% of children with cancer who were diagnosed with COVID-19 developed severe infections, compared to between 1% and 6% of children without cancer who have COVID-19.

In addition to more severe or critical infections, pediatric patients with cancer were more likely to be hospitalized and die than were other children. The pandemic also caused major disruptions to cancer treatments, with effects observed more significantly in low- and middle-income countries. Notably, these countries also had nearly 6-times higher risks of severe or critical disease from COVID-19.

“The results clearly and definitively show that children with cancer fare worse with COVID-19 than children without cancer,” said corresponding officer Sheena Mukkada, MD, of the St. Jude Departments of Global Pediatric Medicine and Infectious Diseases, in a press release. “This global collaboration helps clinicians make evidence-based decisions about prevention and treatment, which, unfortunately, remain relevant as the pandemic continues.”

According to the press release, this is the first multinational study analyzing the outcomes of a large cohort of children and adolescents with cancer or hematopoietic stem cell transplantation and laboratory diagnosis of COVID-19. The study used the Global Registry of COVID-19 in Childhood Cancer, which gathers data on the pandemic’s impact on this patient population. The registry remains open and is enrolling children younger than 19 years of age.

Researchers looked at 1500 children from 131 hospitals in 45 countries between April 15, 2020, and February 1, 2021. This time frame is prior to the availability of vaccinations for older children and is also before the emergence of some variants, including Delta.

The investigators found that 65% of patients were hospitalized and 17% required admission or transfer to a higher level of care. Furthermore, 4% of patients died from COVID-19 infections, compared with a mortality rate between 0.01% and 0.7% among general pediatric patients.

Therapy was also impacted by the pandemic. According to the press release, therapy was modified in 56% of patients and 45% had chemotherapy withheld while their COVID-19 infections were treated.

“By working together to create this global registry, we have enabled hospitals around the world to rapidly share and learn how COVID-19 is affecting children with cancer,” said co-author Kathy Pritchard-Jones, PhD, president of the International Society of Pediatric Oncology, in the press release. “The results are reassuring that many children can continue their cancer treatment safely, but they also highlight important clinical features that may predict a more severe clinical course and the need for greater vigilance for some patients.

Findings from the registry also suggest some biologic factors that could influence how children with cancer respond to COVID-19, such as immune system function and the underlying disease. Further, the analysis found that outcomes vary worldwide, which may be caused by a variety of factors, including disruptions from the pandemic, access to care and resources, or delays in infection diagnosis.

The investigators said their findings are a call to action to address inequities in access to protective and effective treatment measures against the COVID-19 pandemic.

“Understanding a global crisis like COVID-19 requires our entire childhood cancer community around the world to come together to respond,” said senior author Carlos Rodriguez-Galindo, MD, director of St. Jude Global, in the press release. “The impact of this disease has been felt in every corner of the world, but particularly in low- and middle-income countries compared to high-income countries. There are critical differences based on where a child lives. This registry is a tool that is helping us understand what that means for children with cancer everywhere.”


COVID-19 in children with cancer: Severe disease and disrupted treatment. News release. St. Jude Children’s Research Hospital; August 26, 2021. Accessed August 27, 2021.

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