Investigation of the relationship between prolonged PCR positivity and mortality rate in COVID-19 patients with hematological malignancy admitted to the intensive care unit

Year 2026, Volume: 40 Issue: 1, 35 - 49, 28.01.2026

Özlem Öner

https://doi.org/10.18614/dehm.1873586

Abstract

ABSTRACT
BACKGROUND
In patients with hematological malignancies followed in the intensive care unit, the relationship between the number of days of prolonged polymerase chain reaction (PCR) positivity and mortality has not been clarified.
METHODS
All patients with hematological malignancies followed in the intensive care unit and who had a positive PCR test were included in the study. Patients were divided into two groups according to whether they survived or not. The relationship between the number of days of PCR positivity and mortality rate was investigated in these patients.
RESULTS
Among 31 COVID-19 patients with hematological malignancies admitted to the intensive care unit, 7 (22.6%) survived and 24 (77.4%) patients succumbed to the disease. The median duration of PCR positivity was 14 days (6-24) for the entire patient cohort, 11 (4-21) days for survivors, and 24 (21-52) days for non-survivors. Significantly longer PCR positivity times were observed in patients who died compared to survivors (p = 0.019). Acute respiratory distress syndrome (ARDS) was diagnosed in 22 (71%) patients and there was a statistically significant 22 (91.7%) mortality rate in hematologic malignancy patients with ARDS (p = 0.001). Furthermore, the mortality rate in patients receiving invasive mechanical ventilation was 23 (95.8%) (p = 0.001).
CONCLUSION
A relationship between long-term PCR positivity and mortality rates has been demonstrated in patients with hematologic malignancies. This patient group is at unique risk for long-term viral persistence and progressive and fatal respiratory symptoms. We believe that evidence-based strategies that promote viral clearance should be developed to prevent or manage persistent infection.

Keywords

Hematological malignancy , intensive care unit , mortality , prolonged PCR positivity

References

• 1. Fu Y, Li Y, Guo E, He L, Liu J, Yang B, et al. Dynamics and Correlation Among Viral Positivity, Seroconversion, and Disease Severity in COVID-19 : A Retrospective Study. Ann Intern Med. 2021;174(4):453–61.
• 2. Rabaan AA, Tirupathi R, Sule AA, Aldali J, Mutair AA, Alhumaid S, et al. Viral Dynamics and Real-Time RT-PCR Ct Values Correlation with Disease Severity in COVID-19. Diagnostics (Basel). 2021;11(6).
• 3. Passamonti F, Cattaneo C, Arcaini L, Bruna R, Cavo M, Merli F, et al. Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol. 2020;7(10):e737–e45.
• 4. Arcani R, Colle J, Cauchois R, Koubi M, Jarrot PA, Jean R, et al. Clinical characteristics and outcomes of patients with haematologic malignancies and COVID-19 suggest that prolonged SARS-CoV-2 carriage is an important issue. Ann Hematol. 2021;100(11):2799–803.
• 5. 5. Cento V, Colagrossi L, Nava A, Lamberti A, Senatore S, Travi G, et al. Persistent positivity and fluctuations of SARS-CoV-2 RNA in clinically-recovered COVID-19 patients. J Infect. 2020;81(3):e90–e2.
• 6. Kemp SA, Collier DA, Datir RP, Ferreira I, Gayed S, Jahun A, et al. SARS-CoV-2 evolution during treatment of chronic infection. Nature. 2021;592(7853):277–82.
• 7. Lee CY, Shah MK, Hoyos D, Solovyov A, Douglas M, Taur Y, et al. Prolonged SARS-CoV-2 Infection in Patients with Lymphoid Malignancies. Cancer Discov. 2022;12(1):62–73.
• 8. Aydillo T, Gonzalez-Reiche AS, Aslam S, van de Guchte A, Khan Z, Obla A, et al. Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer. N Engl J Med. 2020;383(26):2586–8.
• 9. Eser F, Kayaaslan B, Güner R, Hasanoğlu I, Kaya Kalem A, Aypak A, et al. The Effect of prolonged PCR Positivity on patient Outcomes and Determination of Isolation period in COVID-19 patients. Int J Clin Pract. 2021;75(5):e14025.
• 10. Laracy JC, Kamboj M, Vardhana SA. Long and persistent COVID-19 in patients with hematologic malignancies: from bench to bedside. Curr Opin Infect Dis. 2022;35(4):271–9.
• 11. Ocheni S, Nwagha TU, Amu N, Obodo OI, Okereke K, Chikezie K, et al. COVID-19 in hematological malignancies: Case series and literature review. Ann Afr Med. 2023;22(3):381–4.
• 12. Vijenthira A, Gong IY, Fox TA, Booth S, Cook G, Fattizzo B, et al. Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients. Blood. 2020;136(25):2881–92.
• 13. Ichikawa T, Tamura T, Takahata M, Ishio T, Ibata M, Kasahara I, et al. Prolonged shedding of viable SARS-CoV-2 in immunocompromised patients with haematological malignancies: A prospective study. Br J Haematol. 2024;204(3):815–20.
• 14. Yasuda H, Tsukune Y, Watanabe N, Sugimoto K, Uchimura A, Tateyama M, et al. Persistent COVID-19 Pneumonia and Failure to Develop Anti-SARS-CoV-2 Antibodies During Rituximab Maintenance Therapy for Follicular Lymphoma. Clin Lymphoma Myeloma Leuk. 2020;20(11):774–6.
• 15. Hueso T, Pouderoux C, Péré H, Beaumont AL, Raillon LA, Ader F, et al. Convalescent plasma therapy for B-cell-depleted patients with protracted COVID-19. Blood. 2020;136(20):2290–5.
• 16. Betrains A, Godinas L, Woei AJF, Rosseels W, Van Herck Y, Lorent N, et al. Convalescent plasma treatment of persistent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in patients with lymphoma with impaired humoral immunity and lack of neutralising antibodies. Br J Haematol. 2021;192(6):1100–5.
• 17. Duléry R, Lamure S, Delord M, Di Blasi R, Chauchet A, Hueso T, et al. Prolonged in-hospital stay and higher mortality after Covid-19 among patients with non-Hodgkin lymphoma treated with B-cell depleting immunotherapy. Am J Hematol. 2021;96(8):934–44.
• 18. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405–7.
• 19. Marasco V, Carniti C, Guidetti A, Farina L, Magni M, Miceli R, et al. T-cell immune response after mRNA SARS-CoV-2 vaccines is frequently detected also in the absence of seroconversion in patients with lymphoid malignancies. Br J Haematol. 2022;196(3):548–58.
• 20. Ghione P, Gu JJ, Attwood K, Torka P, Goel S, Sundaram S, et al. Impaired humoral responses to COVID-19 vaccination in patients with lymphoma receiving B-cell-directed therapies. Blood. 2021;138(9):811–4.
• 21. Cattaneo C, Daffini R, Pagani C, Salvetti M, Mancini V, Borlenghi E, et al. Clinical characteristics and risk factors for mortality in hematologic patients affected by COVID-19. Cancer. 2020;126(23):5069–76.
• 22. Martinot M, Jary A, Fafi-Kremer S, Leducq V, Delagreverie H, Garnier M, et al. Emerging RNA-Dependent RNA Polymerase Mutation in a Remdesivir-Treated B-cell Immunodeficient Patient With Protracted Coronavirus Disease 2019. Clin Infect Dis. 2021;73(7):e1762–e5.
• 23. Viana R, Moyo S, Amoako DG, Tegally H, Scheepers C, Althaus CL, et al. Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa. Nature. 2022;603(7902):679–86.
• 24. Tian D, Sun Y, Xu H, Ye Q. The emergence and epidemic characteristics of the highly mutated SARS-CoV-2 Omicron variant. J Med Virol. 2022;94(6):2376–83.