Journal
CANCER DISCOVERY
Volume 12, Issue 1, Pages 62-73Publisher
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/2159-8290.CD-21-1033
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Funding
- NIH/NCI Cancer Center Support Grant [P30 CA 008748, U01 CA228963]
- V Foundation
- Lustgarten Foundation [R01 CA240924]
- Lymphoma Research Foundation
- Jack and Dorothy Byrne Foundation
- Pershing Square Sohn Cancer Research Foundation
- Conrad Hilton Foundation
- Parker Institute for Cancer Immunotherapy
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Persistent COVID-19 infection is more likely to occur in patients with hematologic malignancies, particularly B-cell lymphomas. Active therapy and diminished T-cell counts are associated with acute mortality, while B cell-depleting therapy is the main cause of rehospitalization. Patients with persistent infection show high viral entropy, especially those with impaired CD8(+) T-cell immunity. These findings highlight the need for additional therapeutic strategies to clear the virus in immunocompromised patients.
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.
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