Effectiveness of Paxlovid in the treatment of the SARS-CoV-2 Omicron variant infection in children with hematologic malignancies: a retrospective cohort study
Xiaoxia Deng, Yuelian Jiang, Wenjuan Chen, Xia Qin, Jing Chen, Hao Li, MD Qing Cao
Translational Cancer Research, doi:10.21037/tcr-24-70
Background: Patients with hematologic malignancies (HMs) may be immunocompromised after receiving anti-tumor therapy. Those who also have the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection face many challenges, including a lack of effective antiviral drugs. This study aimed to investigate the clinical features of the SARS-CoV-2 Omicron variant infection in children with HMs, and the effectiveness of Paxlovid. Methods: A retrospective, non-randomized study was conducted on pediatric patients with HMs infected with the SARS-CoV-2 Omicron variant who had been admitted to the Shanghai Children's Medical Center, Shanghai, China from December 1, 2022 to March 1, 2023. The Paxlovid-treated group (Group P) comprised 21 patients, and the non-Paxlovid-treated group (Group N) comprised 21 patients. The patients' demographic data, clinical features, and therapeutic outcomes were collected. Statistical tests were used to evaluate the effectiveness of the treatment and related factors. Results: The clinical course of the SARS-CoV-2 Omicron variant infection for most of the children with HMs was non-severe (97.6%), and only one child progressed to severe disease (2.4%). The most common symptoms were fever (66.7%) and cough (52.4%). Compared with the children in Group N, those in Group P had worse clinical characteristics, including those who previously underwent hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor T (CAR-T) cell treatment (71.4% vs. 28.6%, P=0.005), and those in the myelosuppressive phase (57.1% vs. 4.8%, P<0.001). Most of the children in Group P were treated with more than two types of antibiotics (76.2% vs. 42.9%, P=0.02). The patients treated with Paxlovid within 5 days of diagnosis had a median viral clearance time of 5 days [interquartile range (IQR), 4-8 days], which was significantly shorter than that of the patients who were not treated with Paxlovid (P=0.03). There were no significant differences in the clinical outcomes between the two groups after the propensity score matching (PSM) analyses. Eight patients (19%) had repeat-positive (re-positive) test results. No factor was found to be statistically significant in predicting re-positive test results based on the binary logistic regression analysis. Conclusions: Administering Paxlovid within 5 days of the diagnosis of the SARS-CoV-2 Omicron variant infection in children may effectively shorten the clearance time of the virus, but there is still the possibility the patients may have re-positive test results.
References
Cesaro, Mikulska, Hirsch, Update of recommendations for the management of COVID-19 in patients with haematological malignancies, haematopoietic cell transplantation and CAR T therapy, from the 2022 European Conference on Infections in Leukaemia (ECIL 9), Leukemia
Chien, Peterson, Young, Outcomes of breakthrough COVID-19 infections in patients with hematologic malignancies, Blood Adv
Haeusler, Ammann, Carlesse, SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients, Eur J Cancer
Hall, Teh, COVID-19 Vaccination in Patients With Cancer and Patients Receiving HSCT or CAR-T Therapy: Immune Response, Real-World Effectiveness, and Implications for the Future, J Infect Dis
Hashmi, Bodea, Patni, COVID-19 in Pediatric Patients With Acute Lymphoblastic Leukemia or Lymphoma, JAMA Netw Open
Ichikawa, Tamura, Takahata, Prolonged shedding of viable SARS-CoV-2 in immunocompromised patients with haematological malignancies: A prospective study, Br J Haematol
Katsuya, Yoshida, Takashima, Immunogenicity after vaccination of COVID-19 vaccines in patients with cancer: a prospective, single center, observational study, Int J Clin Oncol
Najjar-Debbiny, Gronich, Weber, Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients, Clin Infect Dis
New, Cham, Smith, Effects of antineoplastic and immunomodulating agents on postvaccination SARS-CoV-2 breakthrough infections, antibody response, and serological cytokine profile, J Immunother Cancer
Saravolatz, Depcinski, Sharma, Molnupiravir and Nirmatrelvir-Ritonavir: Oral Coronavirus Disease 2019 Antiviral Drugs, Clin Infect Dis
Wekking, Senevirathne, Pearce, The impact of COVID-19 on cancer patients, Cytokine Growth Factor Rev
{ 'indexed': {'date-parts': [[2024, 8, 30]], 'date-time': '2024-08-30T00:39:13Z', 'timestamp': 1724978353632},
'reference-count': 0,
'publisher': 'AME Publishing Company',
'issue': '8',
'content-domain': {'domain': ['amegroups.com'], 'crossmark-restriction': False},
'short-container-title': ['Transl Cancer Res'],
'published-print': {'date-parts': [[2024, 8]]},
'DOI': '10.21037/tcr-24-70',
'type': 'journal-article',
'created': {'date-parts': [[2024, 8, 12]], 'date-time': '2024-08-12T07:11:30Z', 'timestamp': 1723446690000},
'page': '4219-4230',
'update-policy': 'http://dx.doi.org/10.21037/ame_crossmark_policy',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': [ 'Effectiveness of Paxlovid in the treatment of the SARS-CoV-2 Omicron variant infection in '
'children with hematologic malignancies: a retrospective cohort study'],
'prefix': '10.21037',
'volume': '13',
'author': [ {'given': 'Xiaoxia', 'family': 'Deng', 'sequence': 'first', 'affiliation': []},
{'given': 'Yuelian', 'family': 'Jiang', 'sequence': 'additional', 'affiliation': []},
{'given': 'Wenjuan', 'family': 'Chen', 'sequence': 'additional', 'affiliation': []},
{'given': 'Xia', 'family': 'Qin', 'sequence': 'additional', 'affiliation': []},
{'given': 'Jing', 'family': 'Chen', 'sequence': 'additional', 'affiliation': []},
{'given': 'Hao', 'family': 'Li', 'sequence': 'additional', 'affiliation': []},
{'given': 'Qing', 'family': 'Cao', 'sequence': 'additional', 'affiliation': []}],
'member': '8611',
'published-online': {'date-parts': [[2024, 8]]},
'container-title': ['Translational Cancer Research'],
'original-title': [],
'link': [ { 'URL': 'https://tcr.amegroups.com/article/download/88997/pdf',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2024, 8, 29]],
'date-time': '2024-08-29T07:54:35Z',
'timestamp': 1724918075000},
'score': 1,
'resource': {'primary': {'URL': 'https://tcr.amegroups.com/article/view/88997/html'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2024, 8]]},
'references-count': 0,
'journal-issue': { 'issue': '8',
'published-online': {'date-parts': [[2024, 8]]},
'published-print': {'date-parts': [[2024, 8]]}},
'URL': 'http://dx.doi.org/10.21037/tcr-24-70',
'relation': {},
'ISSN': ['2218-676X', '2219-6803'],
'issn-type': [{'type': 'print', 'value': '2218-676X'}, {'type': 'electronic', 'value': '2219-6803'}],
'subject': [],
'published': {'date-parts': [[2024, 8]]}}
