key: cord-0904033-cohg77ke
authors: Colaiacovo, Marie‐Laure; Dakhallah, Nawar; Jimenez‐Cortes, Camille; Souza, Amalia; Ah‐Yan, Christophe; Bernier, Pascal; Bittencourt, Henrique; Laverdière, Caroline; Leclerc, Jean‐Marie; Tran, Thai Hoa
title: Comment on: Acute lymphoblastic leukemia onset in a 3‐year‐old child with COVID‐19
date: 2020-09-24
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28727
sha: ebb2cacf398f93b234429e5fe9ec727289ff69d0
doc_id: 904033
cord_uid: cohg77ke

nan

To the Editor, We read the letter entitled "Acute lymphoblastic leukemia onset in a 3-year-old child with COVID-19″ by Marcia et al 1 with interest and we hereby suggest to start chemotherapy within the same timeline as for non-COVID-19 acute lymphoblastic leukemia (ALL) patients, following our experience managing a 3-year-old boy with concomitant diagnoses of precursor B-ALL and COVID-19. The patient was a previously healthy boy who presented to our hospital with a 2-month history of intermittent fevers, night sweats, fatigue, cervical lymphadenopathies, and worsening bone pain. His mother had been tested positive for COVID-19 3 months earlier. At presentation, he had no respiratory symptoms. Physical examination was remarkable for fever, tachycardia, and cervical lymphadenopathies. Blood work revealed pancytopenia and peripheral blasts. Inflammatory markers (ferritin, C-reactive protein, sedimentation rate, fibrinogen, D-dimers) were elevated. Capillary gas, renal function, hepatic function, coagulation studies, cardiac biomarkers, and chest X-ray were normal. COVID-19 testing by 6 Therefore, the general approach to await a negative result prior to begin chemotherapy might cause significant therapy delay and adversely impact outcomes in newly diagnosed ALL patients during the COVID-19 pandemic. Furthermore, the use of COVID-19-specific antiviral treatment in noncritically ill children is controversial given the lack of efficacy in this population. 7 Nevertheless, the benefit of dexamethasone in COVID-19-positive patients requiring respiratory support in reducing early mortality 8 and the exquisite sensitivity of lymphoblasts to corticosteroids could be an effective early strategy to safely initiate therapy in newly diagnosed ALL patients affected with COVID-19, particularly for those presenting with oncologic emergencies such as hyperleukocytosis or mediastinal mass. As we learn more about the impact of SARS-CoV-2 infection in newly diagnosed cancer patients, an individualized assessment of risks and benefits to initiate or delay cancer therapy will need to be carefully balanced based on patient's clinical symptoms, type of malignancy, and available treatment options for now.

Acute lymphoblastic leukemia onset in a 3-year-old child with COVID-19. Pediatr Blood Cancer. 2020;e28423

SARS-CoV-2 infection in children

COVID-19 in Children: initial Characterization of the Pediatric Disease

Early advice on managing children with cancer during the COVID-19 pandemic and a call for sharing experiences

Virological assessment of hospitalized patients with COVID-2019

Multicenter initial guidance on use of antivirals for children with COVID-19/SARS-CoV-2

Dexamethasone in hospitalized patients with Covid-19-preliminary report

The authors declare that there is no conflict of interest.