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Persistent COVID-19 in Patients With Hematological Malignancies: A Focused Review in the Omicron Era

Hajime Yasuda1, Jun Ando2, Miki Ando1

  • 1Department of Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Clinical Lymphoma, Myeloma & Leukemia
|December 27, 2025
PubMed

Insights

Hematological malignancy patients face high COVID-19 mortality and persistent COVID-19 (pCOVID-19). This review offers practical guidance on managing pCOVID-19, including risk factors and antiviral treatments, to aid clinicians.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Oncology

Background:

  • COVID-19 poses a significant threat to patients with hematological malignancies (HM), with high mortality rates and a risk of developing persistent COVID-19 (pCOVID-19).
  • pCOVID-19 can be life-threatening, disrupt essential chemotherapy, pose contagion risks, and lead to the emergence of SARS-CoV-2 multidrug-resistant mutations.
  • Optimal management strategies for pCOVID-19 in HM patients are lacking due to limited evidence from randomized clinical trials.

Purpose of the Study:

  • To conduct a comprehensive literature review on Omicron pCOVID-19 in HM patients.
  • To compile existing evidence and provide practical recommendations for clinicians managing pCOVID-19 in this vulnerable population.
  • To address key aspects of pCOVID-19 management, including risk factors, treatment options, and monitoring.

Main Methods:

  • A comprehensive literature review was performed focusing on Omicron variant pCOVID-19 in patients with hematological malignancies.
  • Scattered evidence from case reports and small case series was compiled and analyzed.
  • Key topics such as vaccination efficacy, risk factors, treatment modalities, and monitoring strategies were synthesized.

Main Results:

  • Identified risk factors for pCOVID-19 in HM patients, including B-cell depleting agents, bendamustine + rituximab, and bispecific T-cell engagers.
  • Reviewed treatment strategies for pCOVID-19, encompassing extended, sequential, and combination therapies with antivirals (nirmatrelvir/ritonavir, remdesivir, molnupiravir, ensitrelvir) and immunotherapies (convalescent plasma, IVIG).
  • Discussed monitoring pCOVID-19 using reverse transcription (RT)-PCR and optimal target cycle threshold values.

Conclusions:

  • pCOVID-19 presents unique challenges for hematological malignancy patients, impacting their underlying disease and treatment.
  • Evidence-based recommendations for managing pCOVID-19 in HM patients are crucial for clinical practice.
  • Further research is needed to establish definitive management guidelines for pCOVID-19 in this immunocompromised population.

Keywords:
Anti-CD20 monoclonal antibody therapyB-cell depleting therapyImmunocompromisedNon-Hodgkin lymphoma (NHL)Reverse transcription (RT)-PCR cycle threshold values

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