Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, Japan.
Eur J Haematol. 2023 Jul;111(1):57-62. doi: 10.1111/ejh.13967. Epub 2023 Mar 30.
The higher risk of prolonged viral shedding in coronavirus disease (COVID-19) patients with hematological malignancies (HM) necessitates test-based de-isolation strategies. However, evidence to establish their appropriate isolation period is insufficient. This study investigated the factors affecting prolonged viral shedding and the requisite isolation period in these patients.
We retrospectively reviewed 14 COVID-19 patients with HM between January and April 2022, who were subjected to our test-based de-isolation strategy, followed by analysis of the viral load trajectory. The viral loads of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were evaluated using the cycle threshold (C ) of the reverse-transcription quantitative polymerase chain reaction. The trajectories were classified according to the time-interval from COVID-19 onset to the attainment of C values >30.
The median interval between onset and attainment of a C value >30 was 22 days. Five patients with mild or moderate COVID-19 without intense treatment histories achieved C values >30 within 20 days. The other nine patients needed more than 20 days, including three patients who did not meet this criterion during the observation period.
The SARS-CoV-2 viral load trajectories in patients with HM can be stratified by treatment history for the underlying HM and severity of COVID-19.
患有血液恶性肿瘤（HM）的冠状病毒病（COVID-19）患者病毒持续排出的风险较高，因此需要基于检测的解除隔离策略。然而，确定其适当隔离期的证据不足。本研究旨在探讨影响这些患者病毒持续排出时间的因素，以及所需的隔离期。
我们回顾性分析了 2022 年 1 月至 4 月期间 14 例患有 HM 的 COVID-19 患者，他们接受了我们的基于检测的解除隔离策略，并对病毒载量轨迹进行了分析。使用逆转录定量聚合酶链反应（RT-qPCR）的循环阈值（C）评估严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的病毒载量。根据从 COVID-19 发病到 C 值>30 的时间间隔，将轨迹进行分类。
发病至 C 值>30 的中位间隔时间为 22 天。5 例无严重疾病且无强化治疗史的轻症或中症 COVID-19 患者在 20 天内达到了 C 值>30。其他 9 例患者需要超过 20 天，包括 3 例在观察期间未达到该标准的患者。
HM 患者的 SARS-CoV-2 病毒载量轨迹可以根据基础 HM 的治疗史和 COVID-19 的严重程度进行分层。
