Clinical Characteristics and Outcomes of COVID-19 in Pediatric Cancer Patients: A Retrospective Cohort Study

Background: The impact of COVID-19 on pediatric cancer patients remains a critical area of investigation. Objectives: This study aimed to compare the clinical characteristics and outcomes of COVID-19 in children with and without malignancies. Methods: A retrospective cohort study was conducted at Mofid Children's Hospital in Tehran, Iran, from July 2020 to December 2022. The study included 210 children with confirmed SARS-CoV-2 infection: 105 with malignancies (case group) and 105 without malignancies (control group). Clinical presentations, laboratory parameters, imaging findings, and outcomes were analyzed. Results: Children with malignancies exhibited lower rates of fever (P = 0.044), respiratory distress (P = 0.035), and nausea/vomiting (P = 0.002). Significant differences in laboratory findings were observed between the case and control groups, including WBC count (P = 0.007), hemoglobin levels (P < 0.001), platelet count (P = 0.002), and ESR (P = 0.001). Ground-glass opacity on chest imaging was significantly associated with malignancy (P = 0.003). Although not statistically significant, the malignancy group showed a trend toward higher mortality (OR = 2.686, P = 0.105). Thrombotic events were rare in both groups. Conclusions: Pediatric cancer patients with COVID-19 exhibited more severe symptoms and distinct laboratory and imaging findings compared to non-cancer patients. While mortality rates were similar, the trend toward higher risk in the malignancy group highlights the need for specialized management strategies for this vulnerable population.