Risk Factors for Persisting SARS-CoV-2 Infection in Patients with B-Cell Malignancies in the Omicron Era: A Multicenter Cohort Study

Background: 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-CD20 therapy (OR 3.22; 95% 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.