{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:04:46Z","timestamp":1792411486519,"version":"4.4.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>COVID-19 in pediatric patients with acute lymphoblastic leukemia or lymphoma (ALL\/LLy) has not been described in detail and may affect chemotherapy administration and long-term outcomes.<\/jats:p><\/jats:sec>Objective<\/jats:title>To describe the clinical presentation of COVID-19 and chemotherapy modifications in pediatric patients with ALL\/LLy.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This is a retrospective case series of patients at St Jude Children\u2019s Research Hospital and its affiliate sites with newly diagnosed ALL\/LLy who were treated on the Total XVII protocol (NCT03117751) between March 30, 2020, and June 20, 2022. Participants included patients aged 1 to 18 years who were receiving protocol chemotherapy. Acute symptoms and chemotherapy modifications were evaluated for 60 days after the COVID-19 diagnosis, and viral clearance, adverse events, and second SARS-CoV-2 infections were followed up during the 27-month study period.<\/jats:p><\/jats:sec>Exposures<\/jats:title>SARS-CoV-2; all patients were screened at least weekly and at symptom onset and\/or after known exposure to SARS-CoV-2.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Description of the spectrum of COVID-19 illness and chemotherapy modifications.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 308 pediatric patients, 110 (36%) developed COVID-19 at a median age of 8.2 (IQR, 5.3-14.5) years. Sixty-eight patients (62%) were male. Most patients were in the continuation\/maintenance phase of chemotherapy (101 [92%]). Severe disease was rare (7 [6%]) but was associated with older age, higher white blood cell counts at ALL\/LLy diagnosis, lower absolute lymphocyte counts at COVID-19 diagnosis, abnormal chest imaging findings, and SARS-CoV-2 reinfection. Rare but serious thrombotic events included pulmonary embolism and cerebral venous sinus thrombosis (n\u2009=\u20091 for each). No multisystem inflammatory syndrome in children or death was seen. SARS-CoV-2 reinfection occurred in 11 patients (10%) and was associated with older age and with receiving standard or high-risk vs low-risk ALL\/LLy therapy. Chemotherapy interruptions occurred in 96 patients (87%) and were longer for patients with severe disease, SARS-CoV-2 reinfection, and\/or a COVID-19 diagnosis during the pre-Omicron variant period vs the post-Omicron period (after December 27, 2021).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this case series of COVID-19 in pediatric patients with ALL\/LLy, severe COVID-19 was rare, but chemotherapy administration was affected in most patients. Long-term studies are needed to establish the outcomes of COVID-19 in this population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.55727","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T16:31:00Z","timestamp":1708101060000},"page":"e2355727","source":"Crossref","is-referenced-by-count":14,"title":["COVID-19 in Pediatric Patients With Acute Lymphoblastic Leukemia or Lymphoma"],"prefix":"10.1001","volume":"7","author":[{"given":"Saman K.","family":"Hashmi","sequence":"first","affiliation":[{"name":"Department of Oncology, St Jude Children\u2019s Research Hospital, Memphis, Tennessee"},{"name":"Department of Global Pediatric Medicine, St Jude Children\u2019s Research Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Bodea","sequence":"additional","affiliation":[{"name":"Department of Oncology, St Jude Children\u2019s Research Hospital, Memphis, 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Jude Children\u2019s Research Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, St Jude Children\u2019s Research Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Hon","family":"Pui","sequence":"additional","affiliation":[{"name":"Department of Oncology, St Jude Children\u2019s Research Hospital, Memphis, Tennessee"},{"name":"Department of Global Pediatric Medicine, St Jude Children\u2019s Research Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego R.","family":"Hijano","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, St Jude Children\u2019s Research Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Inaba","sequence":"additional","affiliation":[{"name":"Department of Oncology, St Jude Children\u2019s Research Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"issue":"13","key":"zoi231636r1","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72?314 cases from the Chinese Center for Disease Control and Prevention.","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"issue":"10","key":"zoi231636r2","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1016\/S1470-2045(21)00454-X","article-title":"Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with 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