AT and OA, molecular testing and edited the manuscript
AT and OA, molecular testing and edited the manuscript. five patients (2%) died. Multivariable analysis revealed several factors that predict SVI: Age above 12 years (p=0.035), body mass index above 95th percentile (p=0.034), comorbid conditions (p=0.025), absolute neutrophil count 500(p=0.014) and absolute lymphocyte count 300 (p=0.022). Levels of anti-SARS-CoV-2 spike antibodies were obtained for 173 patients at a median of 94 days (range, 14C300) after PCR diagnosis; of them 142 (82%) patients seroconverted; the lowest seroconversion rate was observed in patients with hematological malignancies (79%). Our univariable model showed that the following factors were predictive of low titer: lower ANC, p=0.01; hematologic malignancy, p=0.023; receiving steroids in the last 14 days, p=0.032; time since last chemotherapy or immunosuppressive therapy less than 30 days, p=0.002; and being on active chemotherapy in the last 3 months prior to contamination, p<0.001. Conclusions SARS-CoV-2 antibodies developed in most immunocompromised patients with COVID-19 infection in our study. Mortality was relatively low in our patients. Our univariable and multivariable models showed multiple variables that predict severity of infections and antibody response post COVID-19 infection. These observations may guide choice of active therapy during infection and the best timing of vaccination in this high-risk population. Keywords: SARS-CoV-2, immunocompromised, COVID 19, cancer, children, stem cell transplant, seroconversion, chemotherapy Introduction Although most COVID-19 infections are mild/asymptomatic, several observational cohorts have identified that being older, male, and having multiple comorbid conditions, including obesity, diabetes (especially with elevated hemoglobin A1c), severe asthma, respiratory or heart disease, autoimmune and immunosuppressive conditions, renal failure, and hematologic malignancy or other cancers, are predictors of severe COVID-19 infection and mortality (1, 2). Pediatric patients with primary and secondary immunodeficiency diagnosed with COVID-19 infection have variable outcome, though most (85-90%) survive the illness; they are at higher risk of severe illness and death compared with the general pediatric population; GSK2578215A this risk may be lower than that observed in their adult oncology counterparts (3). While antibody and T cell responses to SARS-CoV-2s structural proteins in healthy convalescent donors are well described, adaptive humoral and cellular immunity has not yet been characterized in pediatric immunocompromised patients (4C8). Preliminary studies in non-immunocompromised subjects with COVID-19 infection reported seroconversion 7 to 14 days following symptom onset, with increased IgM and IgG titers observed during the first month (9C13). Antibody responses among immunocompromised patients, including patients with cancer and hematopoietic stem-cell transplant recipients GSK2578215A infected with SARS-CoV-2, may be diminished compared to those of the general population and Rabbit Polyclonal to SHP-1 have not been fully characterized. It is important to understand the quality of the immune response post natural COVID-19 infection in this highly vulnerable immune-compromised population. Such knowledge will help to predict how effective COVID-19 vaccines are in immunocompromised individuals and which patients will benefit or mount a protective immune response. We aimed to evaluate disease severity and antibody response among our patients prior to vaccination. We identified patients who were infected during the first COVID-19 outbreak in Jordan, which peaked in the middle of November 2020. Patients and methods Study design and participants This is an observational study that was approved by our Institutional Review Board (IRB) (study# 20 KHCC 192?F) for children and adolescent (<19 years at diagnosis) with COVID-19 infection who were GSK2578215A treated at our center. Inclusion criteria included having a current or past diagnosis of cancer, having received a hematopoietic stem-cell transplantation, or having benign hematologic disorder or primary immune deficiency (PID). COVID-19 infection was confirmed in all patients by SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) assay from an oropharyngeal or nasopharyngeal swab collected when they had symptoms suggestive of COVID-19, or swabs from asymptomatic patients who had COVID-19Cinfected contacts, or surveillance swabs collected before anesthesia or hospital admission. After consenting, patients (or their parents) were asked to complete a questionnaire about their exposure, health status, and symptoms. Serology testing was drawn 14 days or more after.