Clinical course of persistent viral positivity in lymphoma patients with COVID-19 infection: a retrospective study

Patients with lymphoma are at high risk of persistent positive COVID-19 detection and intractable pneumonia. The treatment process for these patients is both difficult and lengthy. In this situation, it is urgent to manage effective treatment strategy for this vulnerable group. We analyzed 24 lymphoma patients hospitalized due to COVID-19 infection. Clinical characteristics, treatment processes, co-infections, and risk factors of severe/critical COVID-19 infection were analyzed. We conducted univariate and multivariate analyses to evaluate the risk factors associated with persistent viral detection. A total of 24 lymphoma individuals with a COVID-19 diagnosis were identified. The median age of these patients was 63 years old, and 54% of them were male. The median duration of persistent viral detection was 40 days. Patients with persistent viral detection often experienced repeated fever and had a long and hard treatment process. Their imaging evolution manifested as organizing pneumonia, pulmonary fibrosis, or the recurrence of ground-glass opacity. Compared to PCR tests, the metagenomic next-generation sequencing or target next-generation sequencing tests can better detect COVID-19 and co-infection pathogens. The 6 patients who had severe/critical COVID-19 outcomes differed from patients with mild/moderate COVID-19 infection in terms of white blood cells and prealbumin and took a longer duration of viral positivity. Lymphocyte count reduction and prealbumin decrease were observed in patients with persistent viral detection, suggesting possible associations that require confirmation in larger studies. Lymphoma patients with COVID-19 infection may experience a persistent positive viral detection time, which causes persistent symptoms and repeated hospitalization. Their chest CT images may exhibit atypical evolution such as organizing pneumonia, pulmonary fibrosis, or the recurrence of ground-glass opacity. In this exploratory case series, lymphopenia and low prealbumin were possibly associated with persistent viral detection and severe/critical COVID-19. The treatment process for these patients is both difficult and lengthy, especially in the application of antiviral drugs and steroids. However, due to the high individual variability in treatment options, we were unable to draw a clear conclusion of antiviral treatmentduration or glucocorticoid strategy. More studies are needed to formulate a standard treatment scheme for these patients.