DG Alerts Excerpts: Patients with COVID-19 and with immunosuppression after undergoing hematopoietic stem-cell transplantation or receiving cellular therapies may shed viable SARS-CoV-2 for at least 2 months, suggests a study published in The New England Journal of Medicine.

Teresa Aydillo, Icahn School of Medicine at Mount Sinai, New York, and colleagues employed cell cultures to identify viable virus in serially collected nasopharyngeal and sputum samples that were obtained from 20 immunocompromised patients diagnosed with COVID-19 from March 10 through April 20, 2020. The median age of the cohort was 51 years and 55% were males. The most prevalent underlying diseases included lymphoma (40%) and multiple myeloma (35%), while 20% and 5% of patients had acute leukemia/myelodysplastic syndrome and chronic leukemia, respectively. Eleven patients developed severe COVID-19. 

Eighteen patients received hematopoietic stem-cell transplants or chimeric antigen receptor (CAR) T-cell therapy. Fifteen patients were receiving active immunosuppressive or immunomodulatory drugs, or had received chemotherapy in the past 30 days.

In all, 57 samples were obtained from the time of diagnosis up to over 60 days after COVID-19 diagnosis. Viral RNA was detectable for up to 78 days following symptom onset (interquartile range, 24 to 64 days). Overall, 11 patients had at least one positive isolation. 

Follow-up samples obtained from 5 patients grew virus in culture from 8 and up to 61 days after the symptom onset; 3 patients with viable virus for more than 20 days had received allogeneic hematopoietic stem-cell transplants (2 patients) or CAR T-cell therapy (1 patient) within the previous 6 months and remained seronegative for antibodies to viral nucleoprotein. Two of these patients had severe COVID-19.

Whole-genome sequencing could detect viral reads in all the samples and yielded over 95% complete SARS-CoV-2 genomes for 37 out of 57 nasopharyngeal samples obtained from 17 patients and all 18 cultured specimens. Serial sample genomes were obtained for 11 patients, up to day 63 after the onset of symptoms. The authors noted no major changes in the consensus sequences of the original serial specimens or cultured isolates and the findings were consistent with persistent infection. 

[Reference: https://www.nejm.org/doi/full/10.1056/NEJMc2031670]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA