Background: Sufficient data pertaining to the impact of the COVID-19 pandemic on pediatric cancer patients is still currently lacking. The main aim of this prospective study was to describe clinical management and outcomes of COVID-19 in this vulnerable group. Methods: Conducted between May 1st and November 30, 2020, this study included 76 pediatric oncology patients with confirmed COVID-19. Remdesivir (RDV) was the antiviral therapy used. Results: The median age of patients was 9 years. Sixty patients were on first line treatment. Haematological malignancies constituted 86.8% of patients. 35.4% of cases had severe to critical infections. The commonest presentation was fever (93.4%). Chemotherapy was delayed in 59.2% of cases and doses were modified in 30.2%. The sixty-day overall survival (OS) stood at 86.6%, with mortalities occurring only among critically ill patients. Of sixteen acute leukaemia patients in the first induction phase of treatment, 13 survived and 10 achieved induction remission. A negative PCR within 2 weeks and improvement of radiological findings were statistically related to disease severity (p=0.008 and, 0.002 respectively). Better OS was associated with regression of radiological findings after 30 days from infection (p=0.002). Of the forty-five cases who received RDV, 70% were severe to critically ill cases with comparable outcome to patients who did not receive the drug. Conclusions: Most pediatric cancer patients with COVID-19 should have good clinical outcomes, except for those with critical form of infections. Newly diagnosed cases seem to tolerate induction therapy alongside COVID-19 treatment. RDV was well tolerated with no serious adverse events observed.

Background: Pediatric patients with hematologic malignancies are susceptible to invasive mould sinusitis (IMS). IMS is a rare entity that requires careful attention and prompts management due to its high mortality. Methods: This is a retrospective analysis of pediatric patients with hematological malignancies treated at Children Cancer Hospital Egypt through the period from 2008 till 2016 with proven IMS. Results: Thirty-four patients were diagnosed with IMS. Five 5(15%) patients had an invasive rhino-cerebral fungal disease. Mucormycosis were isolated in 17(50%) patients, Aspergillosis in 13 (38%) patients, and mixed fungal in 4 (12%) patients. Sinuses were the only localized site in (45%). Extra-nasal spread was reported in 20 patients; Sino-pulmonary in 12(35%), Sino-cerebral in 5(15%), and Sino-orbital in 2(5%) patients. Combined antifungal therapy with surgical debridement was done in 59% of patients with a better outcome when compared to those who received only medical antifungal treatment (P = 0.01). The overall mortality rate at week 12 was 35% (12 patients), and IMS attributable mortality was 20% (7 patients). IMS with cerebral extension carried the highest mortality rate for both 12-week all-cause (p=0.04) and fungal-attributable (P=0.01) mortality. Conclusions: Pediatric patients with hematologic malignancies are susceptible to invasive mould sinusitis (IMS). Surgical debridement, combined with antifungal therapy, improves outcomes among those patients. IMS patients with cerebral extension had a higher risk of mortality.