Prolonged Viral Shedding of SARS-CoV-2 in Patients With Underlying Haemato-oncological Disease

Case reports describe prolonged COVID19 shedding in patients with malignant hematological disease. Similarly, we observed extended viral shedding in hemato-oncological patients (HP) at our SARS-CoV-2 unit. This raises the question of whether HP are more susceptible to prolonged SARS-CoV-2 shedding and which aspects of immunosuppression contribute to this phenomenon.

Data from HP treated at a single center between 02/2022 and 02/2023 were retrospectively analyzed. Overall, 47 HP with a positive SARS-CoV-2 PCR test were included. Additional data on 16 HP were retrieved from literature. The duration of SARS-CoV-2 positivity (t[SARS+]) was compared between subgroups with different diagnoses, immune status, and HP with and without medical treatment of SARS-CoV-2.

t[SARS+] of HP was 47 days [interquartile range (IR)=25-95] and 12 HP (19%) were still positive by the end of the follow-up. In our cohort, four HP died while still shedding SARS-CoV-2 [t[SARS+]=47 days (IR=33.5-86)]. Different oncological diagnoses did not influence t[SARS+]. HP under steroids had a significantly longer average t[SARS+] (108 days vs. 45 days; p=0.016). HP with B cell depletion/T cell depletion and leukopenia were found to require more time to test negative for SARS-CoV-2 (p _Logrank <0.05). Vaccinated HP had a significantly shorter duration of viral shedding (vaccinated 35.5 days vs. not vaccinated 86 days; p _Logrank <0.01).

Prolonged viral shedding is a common occurrence in HP. Our data illustrate that HP under immune suppression show a significantly longer t[SARS+]. Furthermore, we demonstrate that vaccination influences the length of viral shedding.