While younger patients generally appear to experience fewer severe
manifestations of the active Coronavirus Disease 2019 (COVID-19)
infection, caused by the novel severe acute respiratory
syndrome-associated coronavirus (SARS-CoV-2), it is not known whether
pediatric and young adult patients with bone marrow failure (BMF), while
intuitively vulnerable, are in fact susceptible to its severe
manifestations. A multi-center collective cohort study from Hubei
Province, China reported that patients with hematological malignancies
were especially susceptible to severe complications associated with
SARS-CoV-2 infection.1 There are only scarce data
reported on the impact of COVID-19 in children and young adult patients
with BMF. We carried out a survey of 38 pediatric institutions,
constituting the North American Pediatric Aplastic Anemia Consortium
(NAPAAC). Twenty-nine institutions reported only 4 of 1205 active
patients with bone marrow failure who were diagnosed with COVID-19.
These four patients presented with relatively mild clinical courses.
We identified two children and two young adult patients with BMF who
tested positive for SARS-CoV-2. Three of these patients were reported
from New York and one patient from Georgia. The patients reported in
this study represent approximately 0.3% of 1205 active patients with
BMF followed at 29 NAPAAC institutions; a prevalence lower than for the
population at large (~2-22%) (www.cdc.gov).
The relatively low number of patients, all of whom presented with
mild-to-moderate clinical features, raises the question of why there
have been so few confirmed COVID-19 affected patients in the BMF
population. Infections might have been reduced by better adherence to
recommendations for social distancing in patients and their families who
were concerned about heightened risk due to their underlying disease.
The immunosuppressed status of this patient population may also have
reduced the SARS-CoV-2 pro-inflammatory features and even prevented
enough symptomatology to be tested for SARS-CoV-2. As well, these four
patients did not have any other comorbidities described as risk factors
for poor outcomes.2
The commonalities in our patient population were: 1) non-Caucasians; 2)
lack of comorbidities other than BMF syndromes; 3) worsening blood
counts of at least one blood cell lineage in 3 out of 4 patients; 4)
absence of multi system inflammatory syndrome; and 5) three of four
patients became SARS-CoV-2 PCR negative. In this survey, we observed
decreased morbidity and mortality in comparison to the published BMF
adult cases with COVID-19.3
NAPAAC recognizes that data from a larger number of patients with BMF
during all phases of treatment will be necessary to determine
appropriate management changes for severely cytopenic patients. Although
the small number of patients precludes conclusions as to why these
younger patients seems to have better outcomes than their older
counterparts these cases appear to offer some reassurance to younger
patients with BMF.
Conflict of Interest statement: The authors do not have
conflicts of interests to declare.