Risk factors for persisting SARS-CoV-2 infection in patients with B-cell malignancies in the Omicron era: A multicenter cohort study

Objectives: Patients with B-cell malignancies are at high risk of persisting SARS-CoV-2 infection, which may delay oncologic treatments and increase morbidity. We aimed to assess risk factors for persisting infection in this population. Methods: We conducted a multicenter retrospective study across five tertiary hospitals between January 1, 2022, and January 1, 2023. Adult patients with B-cell malignancies and SARS-CoV-2 infection were included. Persisting infection was defined as viral shedding >= 21 days with clinical and/or radiological signs. Risk factors were evaluated through multivariable logistic regression. Results: Among 307 patients, 26.1% developed persisting infection. The cohort included non-Hodgkin lymphoma (67.4%), chronic lymphocytic leukemia (19.2%), and Hodgkin lymphoma (9.1%). Independent risk factors included anti-cluster of differentiation 20 therapy (odds ratio [OR], 3.22; 95% confidence interval [CI], 2.37-4.39; P < 0.001), and hospital admission at diagnosis (OR, 5.16; 95% CI, 2.37-12.45; P < 0.001). Early therapy with nirmatrelvir/ritonavir (OR, 0.32; 95% CI, 0.19-0.54; P < 0.001), remdesivir (OR, 0.26; 95% CI, 0.18-0.37; P < 0.001), and sotrovimab (OR, 0.32; 95% CI, 0.15-0.67; P = 0.003) were protective. Mortality at 120 days was higher in the persisting group, though not statistically significant (12.5% vs 8.4%; P = 0.277). Conclusions: Our findings help define risk factors for persisting SARS-CoV-2 infection and support early treatment in patients with B-cell malignancies. (c) 2025 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)