Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2024; 23: 107-115
Особенности течения новой коронавирусной инфекции у детей после трансплантации гемопоэтических стволовых клеток
https://doi.org/10.24287/1726-1708-2024-23-2-107-115Аннотация
Особенности течения новой коронавирусной инфекции (COVID-19) у пациентов с гематологическими/ онкогематологическими заболеваниями, перенесших трансплантацию гемопоэтических стволовых клеток (ТГСК), представляют большой интерес. В связи с этим с января 2020 г. по январь 2023 г. было проведено двуцентровое исследование на базе НМИЦ ДГОИ им. Дмитрия Рогачева и НИИ ДОГиТ им. Р.М. Горбачевой. Исследование являлось ретроспективно-проспективным, нерандомизированным, неинтервенционным и включало детей от 0 до 19 лет с гематологическими/ онкогематологическими заболеваниями и первичными иммунодефицитными синдромами на разных этапах после проведения аллогенной ТГСК с подтвержденным диагнозом COVID-19. Данное исследование одобрено независимым этическим комитетом и утверждено решением ученого совета НМИЦ ДГОИ им. Дмитрия Рогачева. Инфекция COVID-19 была установлена методом полимеразной цепной реакции и подразделялась на легкую, среднетяжелую, тяжелую и крайне тяжелую формы. В исследование были включены 105 детей с медианой возраста 9 лет и преобладанием пациентов мужского пола с соотношением мальчиков и девочек 1,8:1. Основными заболеваниями являлись гемобластозы (73%), доброкачественные гематологические заболевания (14%) и первичные иммунодефицитные синдромы (13%). Наиболее частыми клиническими проявлениями были лихорадка, кишечный синдром и респираторная симптоматика, в 40% случаев инфекция протекала бессимптомно. Фактором, коррелирующим с развитием тяжелых форм заболевания, являлась лимфопения. У пациентов без иммунореконституции отмечалась более длительная персистенция вируса COVID-19: 17 дней против 13, однако достоверных различий получено не было (p = 0,7), различий между формами тяжести и исходами COVID-19 также выявлено не было. Влияния терапии на длительность течения COVID-19, ассоциации между видами лечения и продолжительностью заболевания не наблюдалось. Общая выживаемость реципиентов ТГСК при развитии COVID-19 была ниже по сравнению с нетрансплантированными пациентами: 88% против 94%; p = 0,077.
Список литературы
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16. Wei M., Yuan J., Liu Y., Fu T., Yu X., Zhang Z.-J. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA 2020; 323: 1313–4.
17. Connelly J.A., Chong H., Esbenshade A.J., Frame D., Failing С., Secord Е., Walkovich K. Impact of COVID-19 on Pediatric Immunocompromised Patients. Pediatr Clin North Am 2021; 68 (5): 1029–54.
18. Averbuch D., De La Camara R., Corbacioglu S., Mikulska M., Piñana Sanchez J.L.? et al. COVID-19 in Children Following Hematopoietic Cell Transplantation: A Multinational Study of the European Bone Marrow Transplantation Society (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH). Blood 2021; 138 (S1): 2866. DOI: 10.1182/blood-2021-146748
19. Синяев А.А., Гриненко А.О., Попова М.О., Рогачева Ю.А., Спиридонова А.А., Власова Ю.Ю. и др. Новая коронавирусная инфекция у реципиентов трансплантации гемопоэтических стволовых клеток. Клиническая микробиология и антимикробная химиотерапия 2022; (3): 196–201. DOI: 10.36488/cmac.2022.3.196-201
20. Солопова Г.Г., Цыганова Е.В., Кондрашова А.В., Гордеева Г.Н., Розанцева Е.В., Бегунова С.В. и др. Особенности течения новой коронавирусной инфекции COVID-19 у детей с онкологическими, онкогематологическими и тяжелыми иммунологическими заболеваниями. Опыт НМИЦ ДГОИ им. Дмитрия Рогачева. Вопросы гематологии/онкологии и иммунопатологии в педиатрии 2021; 20 (4): 89‒99. doi: 10.24287/17261708-2021-20-4-89-99
21. Haeusler G.M., Ammann R.A., Carlesse F., Groll A.H., Averbuch D., Castagnola E., et al. SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients. Eur J Cancer 2021; 159: 78–86.
Pediatric Hematology/Oncology and Immunopathology. 2024; 23: 107-115
The clinical course of the novel coronavirus disease in children after allogeneic hematopoietic stem cell transplantation
https://doi.org/10.24287/1726-1708-2024-23-2-107-115Abstract
The clinical course of the novel coronavirus disease (COVID-19) in patients with oncological and hematological diseases after hematopoietic stem cell transplantation (HSCT), are of special interest. To further investigate the problem, a two-center study was undertaken at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology and the R.M. Gorbacheva National Research Institute for Pediatric Oncology, Hematology and Transplantation between January 2020 and January 2023. This was a retrospective-prospective, non-randomized, non-interventional study that included children aged 0–19 years with oncological and hematological diseases and primary immunodeficiencies who had undergone allogeneic HSCT and subsequently contracted COVID-19. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. COVID-19 cases were confirmed by polymerase chain reaction testing and classified as asymptomatic, mild, moderate, severe, and critical. The study included 105 patients with a median age of 9 years; male patients were predominant (the male-to-female ratio was 1.8:1). The primary diseases were hematological malignancies (73%), benign hematological diseases (14%) and primary immunodeficiencies (13%). The most common clinical symptoms of COVID-19 were fever, gastrointestinal symptoms, and respiratory symptoms; 40% of COVID-19 cases were asymptomatic. Lymphopenia was found to be a risk factor for severe COVID-19. The patients without immune reconstitution had a longer persistence of the COVID-19 virus than those with immune reconstitution (17 days versus 13 days), however, no significant differences were obtained (p = 0.7). There were also no significant differences in the severity and outcomes of COVID-19 between the patients with immune reconstitution and those without reconstitution. There was no effect of therapy on the duration of COVID-19, and there was no association between the type of treatment and the duration of the disease. The overall survival rate in the allo-HSCT recipients who had been diagnosed with COVID-19 was 88%, which was lower than in the non-recipients (88% vs 94%; p = 0,077).
References
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4. Balashov D., Trakhtman P., Livshits A., Kovalenko I., Tereshenko G., Solopova G., et al. SARS-CoV-2 convalescent plasma therapy in pediatric patient after hematopoietic stem cell transplantation. Transfus Apher Sci 2021; 60 (1): 102983.
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11. Ljungman P., de la Camara R., Mikulska M., Tridello G., Aguado B., Al Zahrani M., et al. COVID-19 and stem cell transplantation; results from an EBMT and GETH multicenter prospective survey. Leukemia 2021; 35: 2885–94. DOI: 10.1038/s41375-02101302-5
12. Aleshina O., Zakurdaeva K., Vasileva A., Dubov S., Dubov V., Vorobyev V., et al. Clinical outcomes in patients with COVID-19 and hematologic disease. [Electronic resource] URL: https://pubmed.ncbi.nlm.nih.gov/?term=Samoylova%20OS%5BAuthor%5D (accessed 14.04.2024).
13. Lu X., Zhang L., Du H., Jiang Zh., Li Y., Qu J., et al. SARS‐CoV‐2 infection in children. N Engl J Med 2020; 382: 1663–5. (accessed 13 April 2023).
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15. Ji L.-N., Chao S., Wang Y.-J., Li X.-J., Mu X.-D., Lin M.-G., et al. Clinical features of pediatric patients with COVID-19: a report of two family cluster cases. World J Pediatr 2020; 16 (3): 267–70.
16. Wei M., Yuan J., Liu Y., Fu T., Yu X., Zhang Z.-J. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA 2020; 323: 1313–4.
17. Connelly J.A., Chong H., Esbenshade A.J., Frame D., Failing S., Secord E., Walkovich K. Impact of COVID-19 on Pediatric Immunocompromised Patients. Pediatr Clin North Am 2021; 68 (5): 1029–54.
18. Averbuch D., De La Camara R., Corbacioglu S., Mikulska M., Piñana Sanchez J.L.? et al. COVID-19 in Children Following Hematopoietic Cell Transplantation: A Multinational Study of the European Bone Marrow Transplantation Society (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH). Blood 2021; 138 (S1): 2866. DOI: 10.1182/blood-2021-146748
19. Sinyaev A.A., Grinenko A.O., Popova M.O., Rogacheva Yu.A., Spiridonova A.A., Vlasova Yu.Yu. i dr. Novaya koronavirusnaya infektsiya u retsipientov transplantatsii gemopoeticheskikh stvolovykh kletok. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya 2022; (3): 196–201. DOI: 10.36488/cmac.2022.3.196-201
20. Solopova G.G., Tsyganova E.V., Kondrashova A.V., Gordeeva G.N., Rozantseva E.V., Begunova S.V. i dr. Osobennosti techeniya novoi koronavirusnoi infektsii COVID-19 u detei s onkologicheskimi, onkogematologicheskimi i tyazhelymi immunologicheskimi zabolevaniyami. Opyt NMITs DGOI im. Dmitriya Rogacheva. Voprosy gematologii/onkologii i immunopatologii v pediatrii 2021; 20 (4): 89‒99. doi: 10.24287/17261708-2021-20-4-89-99
21. Haeusler G.M., Ammann R.A., Carlesse F., Groll A.H., Averbuch D., Castagnola E., et al. SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients. Eur J Cancer 2021; 159: 78–86.
