key: cord-0805409-g86nrv22
authors: Chandar, Rumesh; Swaminathan, Venkateswaran Vellaichamy; Meena, Satishkumar; Varla, Harika; Uppuluri, Ramya; Raj, Revathi
title: The impact of COVID-19 in children post hematopoietic stem cell transplantation: Experience from a pediatric transplant unit in India
date: 2021-12-20
journal: Pediatric Hematology Oncology Journal
DOI: 10.1016/j.phoj.2021.12.003
sha: 075810947fecad53dde6b67a2178be0e04ea5c8b
doc_id: 805409
cord_uid: g86nrv22

Introduction Hematopoietic stem cell transplantation (HSCT) has been particularly challenging during the COVID-19 pandemic. We aimed to analyse the impact of infection with COVID-19 in children post-HSCT and describe the clinical syndromes and the disease manifestations in this cohort. Patients and methods: Children who underwent HSCT between January 2019 to June 2021 and acquired COVID-19 infection were included in the study. The symptomatic children were hospitalized for supportive care. Asymptomatic children were treated in home isolation with azithromycin and zinc supplements. Children who were on immunosuppressants were continued on it. Results: A total of 9/265 children who underwent HSCT in the study period were diagnosed with COVID-19, the incidence being 3.3%. The cycle threshold value in all children was low (≤17), indicating a profound viremia. All children had cytopenia, four had hyponatremia, and two had grade 2 cytokine release syndrome. The severity of the disease was mild in 5 children, moderate in 1 child, and severe in 3 children. Post COVID sequelae included ARDS (n = 1), MIS-C and DVT (n = 1), rhinocerebral rhizopus infection (n = 1). Three children with severe infection died, two due to multiorgan dysfunction and one due to fungal infection. Conclusion: The presence of GVHD, opportunistic fungal infection, and hyponatremia help predict a severe course and mortality in children post HSCT who are diagnosed to have COVID-19 infection. Prophylaxis for mucormycosis in high-risk children with GVHD is an essential aspect of management.

Main text: 1890 continues to have a more significant disease burden.

Allogeneic hematopoietic stem cell transplantation (HSCT) has been particularly challenging 33 and there is paucity of data on the impact of COVID-19 infection in this group of children.

Timely diagnosis due to the marked absence of clinical features, and a predisposition to 

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Indian Council of Medical research. 2021. Guidelines for the management of COVID 205 19 in children below 18 years. Ministry of Health and Family Welfare

COVID-19: An overview of the involvement of the chemokine/chemokine-receptor 210 system