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\begin{document}

\title{Cancer is not a risk factor for severe COVID-19 in children, except in
patients with recent allogeneic hematopoietic stem cell transplantion
recipients or comorbidities.}



\author[1]{Pablo Velasco Puyó}%
\author[2]{Alfredo Tagarro}%
\author[3]{Susana Garcia-Obregon}%
\author[4]{Olatz Villate Bejarano}%
\author[2]{Cinta Moraleda}%
\author[5]{Jorge Huerta Aragonés}%
\author[5]{Eduardo Bardón-Cancho}%
\author[6]{Anna Faura Morros}%
\author[7]{Víctor Galán-Gómez}%
\author[8]{Laura Escobar Fernández}%
\author[9]{Francisco Lendinez-Molinos}%
\author[10]{Blanca Herrero}%
\author[11]{Laura Ureña Horno}%
\author[2]{Nerea Domínguez-Pinilla}%
\author[12]{Juan Francisco Pascual Gazquez}%
\author[13]{Cristina Nova Lozano}%
\author[14]{Marta Osuna-Marco}%
\author[15]{Inés Marín-Cruz}%
\author[4]{Irene Gomez Pastrana}%
\author[3]{Nagore Garcia de Andoin}%
\author[16]{Nerea Gallego Mingo}%
\author[17]{Raquel Portugal Rodríguez}%
\author[18]{Adela Cañete}%
\author[19]{Marta Pareja León}%
\author[20]{Sara Castrillo Bustamante}%
\author[21]{María Tallón García}%
\author[22]{Almudena Gónzalez-Prieto}%
\author[23]{María Solé-Rodríguez}%
\author[24]{Macarena González Cruz}%
\author[1]{Antonio Soriano Arandes}%
\author[25]{Miriam Mota}%
\author[25]{Santiago Pérez-Hoyos}%
\author[1]{Lucas Moreno}%
\author[3]{Itziar Astigarraga-Aguirre}%
\affil[1]{Hospital Universitari Vall d'Hebron}%
\affil[2]{Instituto de Investigacion Hospital 12 de Octubre}%
\affil[3]{Osakidetza Servicio Vasco de Salud}%
\affil[4]{Hospital Universitario 12 de Octubre}%
\affil[5]{Hospital Materno Infantil Gregorio Maranon}%
\affil[6]{Hospital Sant Joan de Deu}%
\affil[7]{Hospital Universitario La Paz Hospital Infantil}%
\affil[8]{Hospital Clinico Universitario de Valladolid}%
\affil[9]{Hospital Infanta Leonor}%
\affil[10]{Hospital Infantil Universitario Nino Jesus}%
\affil[11]{Alicante Hospital General}%
\affil[12]{Hospital Universitario Virgen de las Nieves}%
\affil[13]{Fundacion Investigacion Clinico de Valencia}%
\affil[14]{HM Hospitales}%
\affil[15]{Hospital Universitario Virgen del Rocio Unidad de Pediatria}%
\affil[16]{Hospital Universitario Son Espases}%
\affil[17]{Hospital Universitario de Burgos}%
\affil[18]{Hospital Universitari i Politecnic La Fe}%
\affil[19]{Complejo Hospitalario Universitario de Albacete}%
\affil[20]{Complejo Asistencial de Segovia}%
\affil[21]{Hospital Alvaro Cunqueiro}%
\affil[22]{Hospital Universitario de Salamanca}%
\affil[23]{Hospital Universitario Juan Ramon Jimenez}%
\affil[24]{Hospital Universitario de Canarias}%
\affil[25]{Vall d'Hebron Institut de Recerca}%


\vspace{-1em}



  
  \date{May 27, 2024}


\begingroup
\let\center\flushleft
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\selectlanguage{english}
\begin{abstract}
The EPICO-SEHOP platform gathers data from children with SARS-CoV-2 in
Spain, allowing comparison between children with cancer or allogeneic
hematopoietic stem cell transplantation (alloHSCT) and those without.
The infection is milder in the cancer/alloHSCT group than in children
without comorbidities (7.1\% vs. 15\%), except in children with recent
alloHSCT (less than 300 days), of which 35.7\% experienced severe
COVID-19. These data have been shared with the SEHOP members to support
treatment and isolation policies akin to those for children without
cancer, except for those with recent alloHSCT or additional
comorbidities. This highlights the collaborative registries potential in
managing pandemic emergencies.%
\end{abstract}%



\sloppy


\textbf{INTRODUCTION}

Previous studies have shown that pediatric patients with cancer and
SARS-CoV-2 infection generally have a mild course but with a mortality
rate of 3.8\%, higher than in the general pediatric population according
to previously reports(1--4). This severity is higher in allogeneic
hematopoietic stem cell transplantation (alloHSCT) recipients,
registering a mortality of 5-6\% (5--8).

A recent meta-analysis has shown that the severity and mortality of
COVID-19 in this population is higher in low-middle income countries,
suggesting that the inclusion of countries with different health
resources may influence the analysis of the severity of COVID-19 (2,9).

The comparison of the morbidity and mortality of COVID-19 between
pediatric patients with cancer or HSCT and children without
comorbidities has been made from registries and publications that did
not include both populations, making it difficult to thoroughly analyze
it (7).

The registration and analysis of a population attended with the same
health resources and including the same variables in the pediatric
population without comorbidities and with cancer could help to define
more accurately the clinical characteristics and outcome differences of
this infection between both populations and guide its management in
pediatric oncology units. Therefore, in November 2020, a specific form
designed by the Spanish Society of Pediatric Hematology and Oncology
(SEHOP) for pediatric patients managed in oncological units (with cancer
or alloHSCT) was added to the Spanish general registry of COVID-19 in
children (EPICO-AEP). The aim of this study was to keep treating
physicians updated on the course and management of COVID-19 in children
with cancer in Spain, during the early phases of the pandemic when there
was no literature on this subject. For this purpose, internal analyses
were presented during the national SEHOP congresses in 2021(10) and
2022(11). Here, we analyze these harmonized data.

\textbf{METHODS}

EPICO-AEP is a Spanish multicenter cohort study, approved by the Ethics
Committee of Hospital 12 de Octubre (code 20/101). Eligible participants
were children diagnosed in a hospital with SARS-CoV-2 infection.

Researchers from each participating hospital collected anonymized data
using the electronic system REDCap, including epidemiological,
demographic, clinical and laboratory variables.

To assess whether there may be differences in the impact of COVID-19
depending on the type of cancer or the treatment received, categorizing
them into five groups: solid tumors, lymphoma and acute lymphoblastic
leukemia (ALL), ALL in maintenance, alloHSCT recipients within 300 days,
and alloHSCT recipients beyond 300 days.

To assess risk factors for severe COVID-19, we stratified patient
severity based on oxygen therapy requirements, a more specific and
uniform indicator of severity compared to hospitalization status.

Qualitative variables were described as number and percentage.
Quantitative variables were described as median and interquartile range
(IQR).

Categorical variables were compared using the Chi-squared test. The
comparison of continuous variables between two groups was assessed with
the Student's t-test or Mann--Whitney U test, as appropriate. More than
two groups were analyzed with either ANOVA or Kruskal--Wallis.
Confidence intervals for all analyses were considered at 95\%.

All statistical analyses were performed with R software, Version 4.2.2
(2015 The R Foundation for Statistical Computing)

\textbf{RESULTS}

A total of 1,017 children without cancer or any comorbidities and 257
pediatric patients with cancer or treated with alloHSCT (including 3
patients who received alloHSCT for non-oncological diseases), and
infected with SARS-CoV-2 between March 1st, 2020 and March 1st, 2022,
were reported.

There were 109 reported patients diagnosed with solid tumors, 34 with
lymphoma, 9 with acute myeloid leukemia, 81 with ALL (38 of them in
maintenance), 20 alloHSCT recipients (14 of whom were less than 300 days
post-transplantation).

Table 1 represents the characteristics of the infection in which
significant differences were found between children without
comorbidities and children with cancer/alloHSCT.

No differences were found in the distribution by sex , neither in
contagion at school between children with and without cancer (0,5\% vs
2,9\%, p 0,062)

Within the group of patients with cancer/alloHSCT, vaccinated patients
did not require oxygen while 5.9\% of the unvaccinated patients did.
However, these differences were not statistically significant (p =
0.338). Patients who had received chemotherapy(CT) or radiotherapy(RT)
in the last 30 days before infection did not require more oxygen support
(5\% and 0\% respectively) than patients who had not received CT/RT
(6.7\% and 6.7\%) or received it later (7.7\% and 6.2\%).

Table 2 summarizes the outcomes comparing cancer/alloHSCT subgroups and
children without comorbidities.

Of the 4 patients with cancer/alloHSCT who died from COVID-19, none were
vaccinated, 3 of them had received recent alloHSCT, 1 with primary
immunodeficiency and 2 with ALL, and one patient had a progressive
diffuse midline glioma, with a severe neurological deficit, obesity and
palliative care. Therefore we analyzed the impact of other comorbidities
in children with cancer, 9.9\% of children with both cancer and other
comorbidities required oxygen, compared to 2.2\% for those with cancer
and without comorbidities (p0.043). When comparing patients with cancer
and any other comorbidities to those with neither cancer nor other
comorbidities, the former had lower oxygen need (9.6\% vs 30.8\%,
p\textless{}0.001).

During the period of the \emph{Omicron} variant, the number of cancer
patients registered was higher but milder than those from previous waves
(p 0.181).

\textbf{DISCUSSION}

A common national registry of children with SARS-CoV-2 aims to assess
more accurately whether cancer leads to more severe COVID-19. In our
analysis, severe COVID-19 was more frequently detected in children
without comorbidities (15\%) than in children with cancer (7,1\%),
except in the case of recent alloHSCT (35.7\%), as other studies
reflected (8,12), but unrelated to the date of HSCT.

Despite a mild cancer course in children, the mortality rate is 1.6\%,
which, in our records, is associated with recent alloHSCT or other
comorbidities. These rate is similar to the global GRCCC study (2),
although with lower mortality (3.8\%), probably because our patient's
data are located in a high-income country and during periods where less
severe variants were included (13). Indeed, we found a milder infection,
although not statistically significant, in the later phases of the
pandemic and in vaccinated patients (14--16), and no deaths were
recorded among them. Additionally, other comorbidities increased the
severity in patients with cancer, although their impact was less than in
patients without oncological diseases. Chemotherapy and radiation
therapy did not seem to be related to clinical severity (17).

Nosocomial transmission was higher among children with cancer (11,2\% vs
0,8\%, p\textless{}0,001) , probably due to more frequent hospital
visits. However, school transmission rates were similar between children
with and without cancer, which may be useful to avoid changing the
schooling plan of patients.

Study limitations of selection bias need to be acknowledged, since the
initial screening policies in pediatric oncology units could result in a
higher registration of mild cases. However, there were no reported cases
requiring oxygen or admission to intensive care units in patients with
ALL in maintenance, which highlights the mildness of COVID-19 in this
population (18,19).

In conclusion, our data show that the infection is not more severe in
patients with cancer/alloHSCT, except in patients with recent alloHSCT
or additional comorbidities. These data support, in high-income
countries, a policy of infection management similar to that with other
respiratory viral infections in cancer pediatric patients, directed by
the patient's clinical status or other comorbidities rather than by
isolation of SARS-CoV-2.

\textbf{CONFLICT OF INTEREST STATEMENT}

None of the authors have a conflict of interest to disclose

\textbf{ACKNOWLEDGEMENTS}

We thank the COVID-19 working group for children with cancer from SEHOP
(Ana Fern\selectlanguage{ngerman}ández-Teijeiro, Lucas Moreno, Andres Morales, Anna Faura, Elena
Cela, Itziar Astigarraga, Pablo Velasco), who have guided this study and
other related projects within the society.

We thank the EPICO-AEP registrars who have registered and corrected data
for children with COVID-19 in Spain. The EPICO-AEP project has received
funding from the Carlos III Health Institute (ISCIII) through project
PI20/00995 and co-financed by the European Union; and Asociación
Española de Pediatria (2020 Reseach grant).

Statistical analysis has been carried out in the Statistics and
Bioinformatics Unit (UEB) Vall d'Hebron Hospital Research Institute
(VHIR) and Biocruces Bizkaia Research Institute.

\textbf{EPICO-AEP Working Group:} Francisco José Sanz MD, María Isabel
Iglesias-Bouzas MD, Jose Antonio Alonso Cadenas MD, Blanca Herrero MD
(Hospital Infantil Universitario Niño Jesús, Madrid, Spain), Teresa del
Rosal MD, Ana Méndez-Echevarría MD, Talía Sainz MD, Clara Udaondo MD,
Fernando Baquero MD, Cristina Calvo MD, Carlos Grasa MD, Paula R Molino
MD, María José Mellado MD, María Ceano MD, Victor Galán MD, Paula Garcia
Sanchez MD, Sonsoles San Roman (Hospital Universitario La Paz Madrid,
Spain), Alicia Hernanz Lobo MD, Mar Santos MD, Marisa Navarro MD, Elena
Rincón MD, David Aguilera MD, Begoña Santiago MD, Jorge Huerta MD,
Eduardo Bardón MD, Jorge Lorente (Hospital Universitario Gregorio
Marañón, Spain), Pablo Rojo MD, Daniel Blázquez MD, Luis Prieto MD,
Elisa Fernández-Cooke MD, David Torres-Fernández MD, Ángela Manzanares
MD, Jaime Carrasco MD, Cristina Epalza MD, Jesús Contreras MD, Sara
Domínguez MD, Sara Villanueva MD, Arantxa Gonzalez (Hospital
Universitario 12 de Octubre, Madrid, Spain), Cinta Moraleda MD, Alfredo
Tagarro MD, Elena Cobos MD, Álvaro Ballesteros MD, Sara
Domínguez-Rodriguez (Instituto de Investigación 12 de Octubre, Madrid,
Spain), Gemma Pons MD, Silvia Simó MD, Miguel Lanaspa MD, Victoria
Fumadó MD, Rosa María Pino MD, María Melé (Hospital Sant Joan de Déu,
Barcelon, Spain), María Espiau MD, Jacques G. Rivière MD, Pere
Soler-Palacín MD, Antonio Soriano Arandes MD, Natalia Mendoza (Hospital
Universitari Vall d'Hebron, Barcelona, Spain), Mercedes Herranz MD,
María Urretavizcaya Martínez (Complejo Hospitalario de Navarra, Navarra
, Spain), Fernando Cabañas MD, Fátima Ara MD, Marta Baragaño (Hospital
Universitario Quirónsalud Madrid , Spain), Rut del Valle MD, Ana
González-de-Zárate MD, Mónica Pacheco MD, María Luisa Herreros MD, Julia
Yebra MD, Beatriz Pérez-Seoane MD, María Fernández MD, Teresa Raga MD,
María de la Serna MD, Ane Plazaola MD, Juan Miguel Mesa MD, Rosa Batista
MD, Ana Barrios MD, Ignacio Navarro MD, Jana Rizo MD, Teresa Reinoso MD,
Alfonso Cañete (Hospital Universitario Infanta Sofía, Madrid, Spain),
María Dolores Martín MD, Elena Sáez MD, Olga Nerea Coya MD, Fernando
Cava (BR Salud, Madrid, Spain), Enrique Otheo MD, Juan Carlos Galán MD,
José Luis Vázquez MD, Carmen Vázquez MD, Victor Quintero (Hospital
Universitario Ramón y Cajal, Madrid, Spain), Lola Falcón MD, Olaf Neth
MD, Peter Olbrich MD, Walter Goicoechea MD, Cati Márquez MD, Marisol
Camacho MD, Inés Marín Cruz (Hospital Universitario Virgen del Rocío,
Sevilla, Spain), Laura Martín (Hospital Universitario Regional de
Málaga, Málaga, Spain), Lucía Figueroa (Hospital de Villalba, Madrid,
Spain), María Llorente (Hospital Universitario del Sureste, Madrid,
Spain), María Penin MD, Claudia García MD, María García MD, Teresa
Alvaredo (Hospital Universitario Príncipe de Asturias, Madrid , Spain),
Mª Inmaculada Olmedo MD, Agustín López MD, María Jose Pérez (Hospital
Universitario Puerta de Hierro, Madrid , Spain), Elvira Cobo (Hospital
Fundación Alcorcón, Madrid, Spain), Mariann Tovizi (Hospital del Tajo,
Madrid , Spain), Pilar Galán (Hospital Universitario de Fuenlabrada , ,
Madrid Spain), Beatriz Soto MD, Sara Guillén (Hospital de Getafe, Madrid
, Spain), Adriana Navas (Hospital Universitario Infanta Leonor, Madrid ,
Spain) M. Luz García (Hospital de Leganés, Madrid , Spain), Sara Pérez
(Hospital de Torrejó, Madrid n , Spain), Amanda Bermejo MD, Pablo
Mendoza (Hospital de Móstoles , Spain), Gema Sabrido (Hospital Rey Juan
Carlos , , Madrid Spain), María José Hernández (Hospital Central de la
Defensa, Madrid , Spain), Ana Belén Jiménez (Fundación Jiménez Díaz,
Madrid , Spain), Arantxa Berzosa MD, José Tomás Ramos MD, Marta Illán
(Hospital Clínico San Carlos, Madrid , Spain), Ana López MD, Nerea
Gallego (Hospital Universitari Son Espases, Mallorca , Spain), Beatriz
Ruiz (Hospital Universitario Reina Sofía, Granada, Spain), Santiago
Alfayate MD, Ana Menasalvas MD, Eloísa Cervantes (Hospital Clínico
Universitario Virgen de la Arrixaca, Murcia Spain), María Méndez
(Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol,
Barcelona, Spain), Ángela Hurtado (Instituto Hispalense de Pediatría,
Sevilla , Spain), Cristina García MD, Inés Amich MD, Yolanda Ruiz
(Hospital San Pedro, Logroño , Spain), Manuel Oltra MD, Álvaro
Villarroya-Villalba MD, Adela Cañete MD, Bienvenida Argiles (Hospital
Universitari i Politècnic La Fe, Valencia , Spain), Angustias Ocaña
(Hospital La Moraleja, Madrid , Spain), Isabel Romero MD, María Fernanda
Guzmán (Hospitales Madrid, Madrid , Spain), M.J. Pascual (Hospital Nisa,
Madrid , Spain), María Sánchez-Códez (Hospital Universitario Puerta del
Mar, Cádiz , Spain), Elena Montesinos (Consorci Hospital General
Universitari de València, Valencia , Spain), Julia Jensen MD, María
Rodríguez (Hospital Universitario Infanta Cristina, Madrid , Spain),
Gloria Caro (Hospital Universitario Infanta Elena, Madrid , Spain), Neus
Rius MD, Alba Gómez (Hospital Universitari Sant Joan de Reus, Reus ,
Spain), Rafael Bretón (Hospital Clínico Universitario de Valencia,
Valencia Spain), Margarita Rodríguez MD, Julio Romero MD, Juan Francisco
Pascual Gazquez (Hospital Universitario Virgen de las Nieves, Granada, ,
Spain), Ana Campos (Hospital Universitario Sanitas La Zarzuela, Madrid ,
Spain), Mercedes García (Hospital de Mérida , Mérida, Spain), Rosa María
Velasco (Complejo Hospitalario de Toledo, Toledo , Spain), Zulema Lobato
(Althaia MD, Xarxa Assistencial Universitària de Manresa, Manresa ,
Spain), Fernando Centeno MD, Elena Pérez MD, Alfredo Cano (Hospital
Universitario Río Hortega, Valladolid , Spain), Paula Vidal (Hospital
Clínico Universitario Lozano Blesa, Zaragoza , Spain), Corsino Rey MD,
Ana Vivanco MD, Maruchi Alonso (Hospital Universitario Central de
Asturias, Oviedo , Spain), Pedro Alcalá MD, Javier González de Dios MD,
Laura Ureña Horno (Hospital General Universitario de Alicante, Alicante
, Spain), Eduard Solé MD, Laura Minguell (Hospital Universitari Arnau de
Vilanova, Catalunya , Spain), Itziar Astigarraga PhD, Olatz Villate ,
Susana García Obregón (Hospital Universitario de Cruces, Bilbao ,
Spain), Mª Ángeles Vázquez MD, Miguel Sánchez MD, Leticia Martínez
Campos (Hospital Universitario Torrecárdenas , Almería, Spain), Elena
Díaz (Hospital Virgen de la Luz, Spain), Eduardo Consuegra MD, Susana
Riesco MD, Almudena González MD, Maika Mendoza (Hospital Universitario
de Salamanca, Salamanca, Spain), María Cabanillas (Complejo Asistencial
Universitario de Palencia, Palencia , Spain), Yeray Novoa-Medina MD,
Elena Colino-Gil MD, Ana Reyes-Domínguez MD, Luis Peña-Quintana
(Hospital Universitario Materno Infantil de las Palmas, Las Palmas ,
Spain), Elisa Garrote MD, Maite Goicoechea (Hospital Universitario de
Basurto, Basurto , Spain), Irene Centelles (Hospital General
Universitari de Castelló, Castelló , Spain), Santiago Lapeña MD, Sara
Gutiérrez MD, Soraya Gutiérrez (Complejo Asistencial Universitario de
León, León , Spain), Amparo Cavalle (PIUS Hospital de Valls, Valls ,
Spain), José María Olmos (Hospital Mare de Déu dels Lliris, Catalunya,
Spain), Alejandro Cobo MD, Sara Díaz MD, Cristina Martinez Faci MD,
Macarena Gonzalez Cruz MD, Beatriz Castro (Hospital Universitario de
Canarias, Tenerife , Spain), Beatriz Jiménez MD, Cristina Alvarez
Alvarez (Hospital Universitario Marqués de Valdecilla, Santander ,
Spain), Raúl González (Hospital Sant Joan d'Alacant , Alicante, Spain),
Miguel Lafuente MD, Matilde Bustillo (Hospital Infantil de Zaragoza,
Zaragoza, Spain), Natividad Pons MD, Julia Morata (Hospital Lluís
Alcanyis, Catalunya , Spain), Elsa Segura (Hospital Universitario Son
Llatzer de Palma de Mallorca , Spain), María Bernardino (Universidad
Europea de Madrid , Spain), Marta Pareja León (Complejo Hospitalario
Universitario de Albacete , Albacete, Spain), Ana Domingo Ruiz (Hospital
de Manacor, Mallorca , Spain), Eider Oñate Vergara V MD, Carmen García
MD, Nagore Garcia de Andoin Barandiaran (Hospital Universitario Donostia
, Donostia, Spain), Nerea Domínguez-Pinilla (Hospital Virgen de la
Salud, Spain), María Teresa Coll Sibina (Hospital General de Granollers
, Granollers, Spain), María Jesús García García (Hospital Universitario
de Cáceres , Cáceres, Spain), Marta Osuna (Hospital HM Montepríncipe,
Madrid, Spain), Raquel Portugal (Hospital Universitario de Burgos,
Burgos, , Spain), Leonor García Maset (Hospital de Sagunto, Valencia,
Spain), Belén Sevilla (Hospital Universitario San Cecilio, Granada ,
Spain), Noelia Berciano Jiménez (Hospital Virgen Macarena, Sevilla ,
Spain).

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stem cell transplantation patients during SARS-CoV-2 pandemic. Pediatr
Blood Cancer. 2020 Sep;67(9):e28557.

14. Ilinca AP, Dakhallah N, Souza AM, Leclerc M, Mezziani S, Brossard J,
et al. Update: Clinical characteristics and outcomes of SARS\selectlanguage{english}-CoV\selectlanguage{english}-2
infection in pediatric oncology patients in the province of Quebec.
Pediatr Blood Cancer. 2022 Aug 21;e29936.

15. Pagano L, Salmanton-Garcia J, Marchesi F, Blennow O, Gomes da Silva
M, Glenthoj A, et al. Breakthrough COVID-19 in vaccinated patients with
hematologic malignancies: results from the EPICOVIDEHA survey. Blood.
2022 Dec 29;140(26):2773--87.

16. Salmanton-Garcia J, Marchesi F, Glenthoj A, Bilgin YM, van Praet J,
Davila-Valls J, et al. Improved Clinical Outcome of COVID-19 in
Hematologic Malignancy Patients Receiving a Fourth Dose of
Anti-SARS-CoV-2 Vaccine: An EPICOVIDEHA Report. Hemasphere. 2022
Nov;6(11):e789.

17. Parambil BC, Moulik NR, Dhamne C, Dhariwal N, Narula G, Vora T, et
al. COVID-19 in Children with Cancer and Continuation of Cancer-Directed
Therapy During the Infection. Indian J Pediatr. 2022 May
1;89(5):445--51.

18. Millen GC, Arnold R, Cazier JB, Curley H, Feltbower R, Gamble A, et
al. COVID-19 in children with haematological malignancies. Arch Dis
Child. 2022 Feb;107(2):186--8.

19. Zama D, Baccelli F, Colombini A, Contino A, Calore E, Petris MG, et
al. Favorable outcome of SARS-CoV-2 infection in pediatric hematology
oncology patients during the second and third pandemic waves in Italy: a
multicenter analysis from the Infectious Diseases Working Group of the
Associazione Italiana di Ematologia e Oncologia Pediatrica (AIEOP). Ann
Hematol. 2022 Aug 1;101(8):1843--51.

\textbf{TABLE 1. - Characteristics of SARS-CoV-2 infection in children
without comorbidities and children with cancer.} Descriptive analysis
(mean (SD); N (\%)) and p values obtained by Chi-Squared, Fisher,
Mann-Whitney test or logistic regression. Only significant variables are
shown.\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{No cancer, no comorbidities} \textbf{(n=1017)}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{Cancer} \textbf{(n=257)}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{All} \textbf{(n=1274)}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{p}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\selectlanguage{greek}\textbf{n\textsuperscript{α}}\selectlanguage{english}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Age (years)}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5.1 (5,3)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9.2 (5,2)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5.8 (5.5)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1230\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Health care exposure associated with infection}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8 (0.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
24 (11.2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
32 (2.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
123\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Household exposure associated with infection}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
428 (42.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
37 (17.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
465 (37.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1231\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{COVID-19 vaccine}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
10 (6.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
35 (25.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
45 (15.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
292\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Waves*} \textbf{1} \textbf{2} \textbf{3} \textbf{4} \textbf{5}
\textbf{6}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
212 (21\%) 390 (38.6\%) 126 (12.5\%) 38 (3.8\%) 60 (5.9\%) 185
(18.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
33 (29.2\%) 25 (22.1\%) 9 (8\%) 2 (1.8\%) 3 (2.7\%) 41 (36.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
245 (21.8\%) 415 (36.9\%) 135 (12\%) 40 (3.6\%) 63 (5.6\%) 226
(20.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textless{}0,001\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1124\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{COVID-19 symptoms}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Fever}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
772 (76.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
67 (53.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
839 (73.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textless{}0.001\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1135\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Cough}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
408 (40.5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
37 (30.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
445 (39.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.033\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1131\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Rhinorrhoea}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
387 (38,4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
35 (28,5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
422 (37,5\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0,036\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1125\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Abdominal pain}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
235 (26,9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13 (10,8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
248 (24,9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textless{}0,001\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
995\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Vomiting/nausea}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
280 (27,9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
20 (16,4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
300 (26,6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0,009\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1127\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Diarrhoea}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
208 (20,7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13 (10,6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
221 (19,6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0,011\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1130\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Codetection\textsuperscript{+}}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
83 (18,3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14 (8,6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
97 (15,7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0,005\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
616\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Radiological image} \textbf{Normal} \textbf{Parenchymatous
condensation} \textbf{Other infiltrates}\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
208 (57,8\%) 50 (13,9\%) 102 (28,3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
52 (74,3\%) 7 (10\%) 11 (15,7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
260 (60,5\%) 57 (13,3\%) 113 (26,3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0,032\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
430\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Oxygen support}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
139 (15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
18 (7,1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
157 (13,3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0,002\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1179\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
\textbf{Hospital admission} Not hospitalized Hospitalized\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
458 (45,9\%) 539 (54,1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
69 (53,1\%) 61 (46,9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
527 (46,8\%) 600 (53,2\%)\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
0,125\strut
\end{minipage} & \begin{minipage}[t]{0.16\columnwidth}\raggedright\strut
1127\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{Death related to COVID-19}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0 (0\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (1,6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
4 (0,31\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
0.002\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
1274\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\selectlanguage{greek}\textsuperscript{α}\selectlanguage{english}Available data

*Waves as incidence of SARS-CoV-2 variants in Spain(3)

\textsuperscript{+}The codetection identified was virus-virus in 45.8\%
of the cases detected and virus-bacteria in 54.2\%

\textbf{TABLE 2. - Comparative outcomes of SARS-CoV-2 infected patients
within each cancer group and those without cancer or
comorbidities.}Descriptive analysis (mean (SD); N (\%)) and p values
obtained by Chi-Squared, Fisher, Mann-Whitney test or logistic
regression. Only significant variables are shown.

\selectlanguage{greek}\textsuperscript{α}\selectlanguage{english}Available data. Allo-HSCT : allogeneic stem cell
transplantation;HSCT : hematopoietic stem cell transplantation . PICU:
Pediatric Intensive Care Unit

Abbreviations: AlloHSCT - Allogeneic Hematopoietic Stem Cell
Transplantation; HSCT - Hematopoietic Stem Cell Transplantation; ALL -
Acute Lymphoblastic Leukemia; PICU - Pediatric Intensive Care Unit.

\selectlanguage{english}
\FloatBarrier
\end{document}

