Chemotherapy and Anti-CD20 Monoclonal Antibody Impact on SARS-CoV-2 Nucleic Acid Amplification Tests in Hematologic Malignancies: A Retrospective Study

Background Patients with hematologic malignancies may experience prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate risk factors for persistent SARS-CoV-2 infection in patients with hematologic malignancies based on nucleic acid amplification test (NAAT) results. Patients with SARS-CoV-2 NAAT positivity lasting ≥ 8 weeks (persistent NAAT-positive group) were compared with those who became NAAT-negative within 8 weeks (non-persistent NAAT-positive group). Methods We examined patients with COVID-19 and hematologic malignancies between April 2021 and January 2023 at Tenri Hospital in Japan, examining hematologic malignancy type, chemotherapy regimens, and laboratory data. Results NAAT results at 8 weeks were available for 43 patients; eight (19%) remained positive for 8 weeks or more, while 35 (81%) became negative in < 8 weeks. Univariate analysis between the two groups showed significant differences in disease severity (p = 0.001), anti-CD20 monoclonal antibodies (mAB) use within the past 6 months (7/8 [88%] vs. 16/35 [46%], respectively; p = 0.05), obinutuzumab use within the past 6 months (3/8 [38%] vs. 2/35 [6%], respectively; p = 0.037), and anti-CD20 mAbs maintenance treatment (3/8 [38%] vs. 1/35 [3%], respectively; p = 0.016). Seven of the eight patients in the persistent NAAT-positive group had malignant lymphomas, and five had follicular lymphoma. Conclusions The use of anti-CD20 mAbs, especially obinutuzumab and maintenance treatment, is associated with long-term SARS-CoV-2 infection in patients with hematologic malignancies.