Prolonged SARS-CoV-2 RNA virus shedding and lymphopenia are hallmarks of COVID-19 in cancer patients with poor prognosis

Patients with cancer are at higher risk of severe coronavirus infectious disease 2019 (COVID-19), but the mechanisms underlying virus-host interactions during cancer therapies remain elusive. This study compared nasopharyngeal swabs from cancer and noncancer patients, finding that malignant disease favors the magnitude and duration of viral RNA shedding, accompanied by prolonged serum elevations of type 1 IFN that anticorrelated with anti-RBD IgG antibodies. Cancer patients with prolonged SARS-CoV-2 RNA detection exhibited typical severe COVID-19 immunopathology, including lymphopenia (worsened by cancer-associated lymphocyte loss) which correlated with COVID-19 severity, chronic SARS-CoV-2 RNA shedding, and higher cancer-related death risk. Lymphocyte loss correlated with metabolic changes and increased gut bacteria DNA. The authors suggest that cancer therapies may exacerbate the link between lymphopenia and COVID-19 immunopathology, and preventing COVID-19-induced lymphocyte loss may reduce cancer-associated death.

Anne-Gaëlle Goubet, Agathe Dubuisson, Arthur Geraud, François-Xavier Danlos, Safae Terrisse, Carolina Alves Costa Silva, Damien Drubay, Lea Tour, Marion Picard, Marine Mazzenga, Aymeric Silvin, Garett Dunsmore, Yacine Haddad, Eugenie Pizzato, Pierre Ly, Caroline Flament, Cléa Melenotte, Eric Solary, Michaela Fontenay, Gabriel Garcia, Corinne Balleyguier, Nathalie Lassau, Markus Maeurer, Claudia Grajeda-Iglesias, Nitharsshini Nirmalathasan, Fanny Aprahamian, Sylvère Durand, Oliver Kepp, Gladys Ferrere, Cassandra Thelemaque, Imran Lahmar, Jean-Eudes Fahrner, Lydia Meziani, Abdelhakim Ahmed-Belkacem, Nadia Saïdani, Bernard La Scola, Didier Raoult, Stéphanie Gentile, Sébastien Cortaredona, Giuseppe Ippolito, Benjamin Lelouvier, Alain Roulet, Fabrice Andre, Fabrice Barlesi, Jean-Charles Soria, Caroline Pradon, Emmanuelle Gallois, Fanny Pommeret, Emeline Colomba, Florent Ginhoux, Suzanne Kazandjian, Arielle Elkrief, Bertrand Routy, Makoto Miyara, Guy Gorochoy, Eric Deutsch, Laurence Albiges, Annabelle Stoclin, Bertrand Gachot, Anne Florin, Mansouria Merad, Florian Scotte, Souad Assaad, Guido Kroemer, Jean-Yves Blay, Aurélien Marabelle, Frank Griscelli, Laurence Zitvogel, Lisa Derosa