Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer

SARS-CoV-2 Viral RNA Shedding for More Than 87 Days in an Individual With an Impaired CD8+ T Cell Response

“…We describe a case of prolonged SARS-CoV-2 viral RNA shedding lasting 87 days after the initial positive clinical PCR test and 97 days after the onset of symptoms. This length of viral RNA shedding is weeks longer than the majority of prolonged viral shedding cases currently reported in the literature (1)(2)(3)(4), however, others have recently reported shedding for similar or longer periods of time in a handful of individuals (5,12). One of these studies has shown that a small number of individuals can shed viable virus that can be cultured ex vivo (5).…”

“…Alternatively, delayed physiologic clearance of non-infectious viral products may be occurring in these individuals who continue to test positive. A recent report demonstrates that at least a small subset of patients with a history of stem-cell transplant, chimeric antigen receptor T cell therapy or lymphoma with persistent viral shedding have virus that can be recovered in cell culture up to 61 days after the onset of symptoms ( 5 ). Understanding why some individuals have delayed clearance of infectious virus and others have delayed clearance of viral RNA may be important for determining immunologic correlates of viral clearance that are critical for vaccine development.…”

Persistent SARS-CoV-2 infectivity greater than 50 days in a case series of allogeneic peripheral blood stem cell transplant recipients

“…( Huang et al, Aug ) Similarly, our second patient continued to have persistently low Ct values in the 20 s up to 49 days post diagnosis, indicating high viral loads and infectious SARS-CoV-2 despite a 5 day course of Remdesivir and entirely asymptomatic course of infection. ( Bullard et al, 2020 ) One study looking at 20 immunocompromised patients with hematologic malignancies also found prolonged viral shedding and viable virus for more than 20 days in 3 patients who had received allogeneic PSCT (2 patients) or CAR T-cell therapy (1 patient) ( Aydillo et al, 2020 ). Of note, this study included 8 patients with lymphoma, 4, patients with acute leukemia, 1 with chronic leukemia and 7 with multiple myeloma; 15 of which who were receiving chemotherapy, but only the allogeneic PBSCT and CAR-T cell patients had prolonged viral viability beyond 20 days.…”

Impact of COVID-19 on Clinical Care and Research in Cancer Imaging: Where We Are Now

“…Dr. Anthony Fauci, Director of the US National Institute for Allergy and Infectious Disease, projects the United States will not return to normalcy until 2022. A recent study suggests particular concern for the virus in immunocompromised cancer patients who may continue shedding SARS-CoV-2 for at least 2 months after infection ( 3 ).…”