Prevalence and Clinical Impact of SARS-CoV-2 Silent Carriers Among Actively Treated Patients with Cancer During the COVID-19 Pandemic

The oncologist

article

Alberto Zambelli¹  Laura Milesi¹  Paola Poletti¹  Cristina Tasca¹  Mario Mandal๠ Barbara Merelli¹  Stefania Mosconi¹  Ermenegildo Arnoldi¹  Anna Bettini¹  Lucia Bonomi¹  Caterina Messina¹  Lorenzo Chiudinelli²  Laura Ghilardi³  Alessandra Chirco³  Michela Maracino¹  Carlo Tondini¹  Vittoria Fotia¹  Giorgia Negrini¹  Tommaso Bosetti¹  Annapaola Callegaro⁴  Andrea Di Croce¹  Elena Rota Caremoli¹  Cecilia Moro¹ 

[1] Department of Medical Oncology, Ospedale Papa Giovanni XXIII;Department of Electrical, Computer and Biomedical Engineering, University of Pavia;Departments of Medical Oncology, Ospedale Papa Giovanni XXIII;Department of Microbiology, Ospedale Papa Giovanni XXIII

关键词: Cancer;    COVID-19;    SARS-CoV-2;    Coronavirus;    Silent carriers;   

DOI  :  10.1002/onco.13654

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Introduction In Europe, the SARS-CoV-2 pandemic had its first epicenter in Italy. Despite a significant mortality rate, the severity of most cases of COVID-19 infection ranges from asymptomatic to mildly symptomatic, and silent infection affects a still-unknown proportion of the general population. No information is available on the prevalence and clinical impact of SARS-CoV-2 silent infection among patients with cancer receiving anticancer treatment during the pandemic. Materials and Methods From April 1, 2020, to the end of the same month, 560 consecutive patients with cancer, asymptomatic for COVID-19 and on anticancer treatment at Papa Giovanni XXIII Hospital in Bergamo, were evaluated and tested for SARS-CoV-2. We implemented a two-step diagnostics, including the rapid serological immunoassay for anti–SARS-CoV-2 immunoglobulin (Ig) G/IgM and the nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test in case of seropositivity to identify SARS-CoV-2 silent carriers. Results In 560 patients, 172 (31%) resulted positive for anti–SARS-CoV-2 IgM/IgG antibodies, regardless of different type of cancer, stage, and treatment. The Ig-seropositive patients were then tested with RT-PCR nasopharyngeal swabs, and 38% proved to be SARS-CoV-2 silent carriers. At an early follow-up, in the 97 SARS-CoV-2–seropositive/RT-PCR–negative patients who continued their anticancer therapies, only one developed symptomatic COVID-19 illness. Conclusion Among patients with cancer, the two-step diagnostics is feasible and effective for SARS-CoV-2 silent carriers detection and might support optimal cancer treatment strategies at both the individual and the population level. The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in cases of RT-PCR–negative patients. Implications for Practice This is the first study evaluating the prevalence and clinical impact of SARS-CoV-2 silent infection in actively treated patients with cancer, during the epidemic peak in one of the worst areas of the COVID-19 pandemic. Lacking national and international recommendations for the detection of asymptomatic SARS-CoV-2 infection, a pragmatic and effective two-step diagnostics was implemented to ascertain SARS-CoV-2 silent carriers. In this series, consisting of consecutive and unselected patients with cancer, the prevalence of both SARS-CoV-2–seropositive patients and silent carriers is substantial (31% and 10%, respectively). The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in case of RT-PCR–negative patients.

【 授权许可】

CC BY|CC BY-NC