CLL-370: The Prolonged Positivity of SARS-CoV-2 RNA in Chronic Lymphocytic Leukemia Patients

CONTEXT: Coronavirus disease 2019 (COVID-19) is a highly infectious disease. A small proportion of COVID patients are positive for SARS-CoV-2 for long time. We report a COVID-19 patient with prolonged presence of SARS-CoV-2 RNA. OBJECTIVE: In this study we evaluate the unexpected evolution of patients with CLL diagnosed with COVID-19. DESIGN AND SETTING: We have a prospective study that included all CLL patients admitted in the Hematology Department of Colentina Clinical Hospital, during April-June 2020. PATIENTS OR OTHER PARTICIPANTS: The study group included 3 CLL patients. All patients were SARS-CoV-2 positive by molecular test. RESULTS: 1st patient: A 53-year-old male diagnosed with COVID on 25th March, 2020, at the onset presented fever, headache, and associated anal abscess. The patient had a history of diabetes mellitus and CLL (starting 2014). The CLL patient was monitored as a “watch and wait” patient until 2019 when started on Ibrutinib (was stopped on 16th March, 2020). He received antiviral+hydroxychloroquine associated with antibiotics Piperacilin/Tazobactam and Linezolid with favourable evolution and resolution of anal abscess. During surgical monitoring (week 3), patient presented fever, chills, cough and dyspnea. CT scan revealed bilateral COVID pneumonia and associated Klebsiella pneumonie infection in sputum by Biofire exam. Antibiotics treatment (Vancomycin, Colimicin, and Meropenem), antifungal treatment (Caspofungin), and Tocilizumab 640 mg was started with favourable evolution but patient is still SARS-CoV-2-positive (50 days). The long-time of positive SARS-CoV-2 status although the patient received COVID treatment including Tocilizumab is not an usual evolution for COVID patient 2nd and 3rd patients watch and wait CLL patients with positive SARS-CoV-2 test and ongoing evolution during 2 weeks. Compared with the rest of patients, including AML or MPN patients (negativity of SARS-CoV-2 test was obtained in maximum 2 weeks), CLL patients had long evolution. CONCLUSIONS: These cases suggest that a small proportion of COVID patients like CLL patients may have prolonged positivity for SARS-CoV-2 RNA although the evolution is not severe.