Clinical characteristics and outcomes of patients with haematologic malignancies and COVID-19 suggest that prolonged SARS-CoV-2 carriage is an important issue

Abstract

Specificities of COVID-19 disease course in patients with haematologic malignancies are still poorly studied. So, we aimed to compare patients with haematologic malignancies to patients without malignancies, matched by sex and age and hospitalised for COVID-19 at the same time and in the same centre. Among 25 patients with haematologic malignancies, we found that mortality (40% versus 4%, p < 0.01), number of days with RT-PCR positivity (21.2 ± 15.9 days [range, 3–57] versus 7.4 ± 5.6 days [range, 1–24], p < 0.01), maximal viral load (mean minimal Ct, 17.2 ± 5.2 [range, 10–30] versus 26.5 ± 5.1 [range, 15–33], p < 0.0001) and the delay between symptom onset and clinical worsening (mean time duration between symptom onset and first day of maximum requirement in inspired oxygen fraction, 14.3 ± 10.7 days versus 9.6 ± 3.7 days, p = 0.0485) were higher than in other patients. COVID-19 course in patients with haematologic malignancies has a delayed onset and is more severe with a higher mortality, and patients may be considered as super-spreaders. Clinicians and intensivists need to be trained to understand the specificity of COVID-19 courses in patients with haematological malignancies. Supplementary Information The online version contains supplementary material available at 10.1007/s00277-021-04656-z.

Clinical course of Coronavirus Disease-19 in patients with haematological malignancies is characterized by a longer time to respiratory deterioration compared to non-haematological ones: results from a case–control study

“…As a matter of fact, so far the majority of studies have included mixed cohorts combining patients with haematological and solid cancer [ 3 , 8 – 10 ]. Whereas, case–control studies, specifically matching subjects with and without haematological malignancies affected by SARS-CoV2, are still rare and include only a few patients [ 11 , 12 ].…”

COVID-19 in Patients with Hematologic Malignancies: Clinical Manifestations, Persistence, and Immune Response

“…While time from infection to symptom onset seems to be similar to the general population, time from symptom onset to maximal required O 2 supplementation is significantly longer (HR 1.48, 95% CI [1.04-1.92]) [20]. Interestingly, while thrombocytopenia seems to be much more prevalent in HM patients with COVID-19 [7], we found no reported evidence of an increased risk of disseminated intravascular coagulopathy or superinfection in this population compared to HM unaffected by COVID-19 [6,[14][15][16][18][19][20][21]. Conversely, some reports show increased venous thromboembolism in HM, although whether CO-VID-19 actually increases venous thromboembolism risk among patients with HM, already at an increased risk due to their malignancy, is unknown [22].…”

“…A plethora of clinical and epidemiological evidence indicates that HM patients infected with COVID-19 have protracted viral shedding and possibly longer infectivity [20]. Technical limitations and safety concerns make viral cultures impractical in assessing viral shedding in most settings.…”

“…Disease course tends to be more prolonged. While time from infection to symptom onset seems to be similar to the general population, time from symptom onset to maximal required O 2 supplementation is significantly longer (HR 1.48, 95% CI [1.04–1.92]) [20]. Interestingly, while thrombocytopenia seems to be much more prevalent in HM patients with COVID-19 [7], we found no reported evidence of an increased risk of disseminated intravascular coagulopathy or superinfection in this population compared to HM unaffected by COVID-19 [6, 14-16, 18-21].…”

“…Patients with HM bear the highest risk of protracted shedding, as evidenced by nasal swabs with Ct >30. In one study, PCR remained positive for a mean of 21.2 days (SD 15.9) in HM patients compared to 7.4 (SD 5.6) in matched controls without HM [20]. One retrospective study [44] compared 70 patients with SM with 35 HM patients.…”