Prolonged SARS-CoV-2 infection in patients with lymphoid malignancies Journal Article


Authors: Lee, C. Y.; Shah, M. K.; Hoyos, D.; Solovyov, A.; Douglas, M.; Taur, Y.; Maslak, P.; Babady, N. E.; Greenbaum, B.; Kamboj, M.; Vardhana, S. A.
Article Title: Prolonged SARS-CoV-2 infection in patients with lymphoid malignancies
Abstract: Coronavirus disease 2019 (COVID-19) infection results in both acute mortality and persistent and/or recurrent disease in patients with hematologic malignancies, but the drivers of persistent infection in this population are unknown. We found that B-cell lymphomas were at particularly high risk for persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity. Further analysis of these patients identified discrete risk factors for initial disease severity compared with disease chronicity. Active therapy and diminished T-cell counts were drivers of acute mortality in COVID-19–infected patients with lymphoma. Conversely, B cell–depleting therapy was the primary driver of rehospitalization for COVID-19. In patients with persistent SARS-CoV-2 positivity, we observed high levels of viral entropy consistent with intrahost viral evolution, particularly in patients with impaired CD8+ T-cell immunity. These results suggest that persistent COVID-19 infection is likely to remain a risk in patients with impaired adaptive immunity and that additional therapeutic strategies are needed to enable viral clearance in this high-risk population. SIGNIFICANCE: We describe the largest cohort of persistent symptomatic COVID-19 infection in patients with lymphoid malignancies and identify B-cell depletion as the key immunologic driver of persistent infection. Furthermore, we demonstrate ongoing intrahost viral evolution in patients with persistent COVID-19 infection, particularly in patients with impaired CD8+ T-cell immunity. © 2021 American Association for Cancer Research.
Keywords: adult; clinical article; aged; gene mutation; nonhuman; interleukin 2; progression free survival; cohort analysis; hematopoietic stem cell transplantation; risk assessment; hospitalization; disease severity; immune response; immunotherapy; blood sampling; microarray analysis; nerve cell adhesion molecule; lymphoma; immunophenotyping; lactate dehydrogenase; virus load; cd4 antigen; immunosuppressive treatment; bioinformatics; t lymphocyte activation; lymphocyte count; ferritin; viral clearance; virus shedding; human; male; female; article; whole exome sequencing; severe acute respiratory syndrome coronavirus 2; nasopharyngeal swab; lymphatic system malignancy
Journal Title: Cancer Discovery
Volume: 12
Issue: 1
ISSN: 2159-8274
Publisher: American Association for Cancer Research  
Date Published: 2022-01-01
Start Page: 62
End Page: 73
Language: English
DOI: 10.1158/2159-8290.Cd-21-1033
PUBMED: 34753749
PROVIDER: scopus
PMCID: PMC8758535
DOI/URL:
Notes: Article -- Export Date: 1 February 2022 -- Source: Scopus
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MSK Authors
  1. Ngolela Esther Babady
    175 Babady
  2. Monika Shah
    22 Shah
  3. Mini Kamboj
    160 Kamboj
  4. Peter Maslak
    197 Maslak
  5. Ying Taur
    147 Taur
  6. Santosha Adipudi Vardhana
    113 Vardhana
  7. David Hoyos
    16 Hoyos
  8. Christina Lee
    7 Lee