Updated COVID-19 clearance time among patients with cancer in the Delta and Omicron waves.

BACKGROUND: COVID-19 infection delays therapy and in-person evaluation for oncology patients, but clinic clearance criteria are not clearly defined. METHODS: We conducted a retrospective review of oncology patients with COVID-19 at a tertiary care center during the Delta and Omicron waves and compared clearance strategies. RESULTS: Median clearance by two consecutive negative tests was 32.0 days (Interquartile Range [IQR] 22.0-42.5, n = 153) and was prolonged in hematologic malignancy versus solid tumors (35.0 days for hematologic malignancy, 27.5 days for solid tumors, p = 0.01) and in patients receiving B-cell depletion versus other therapies. Median clearance by single negative test was reduced to 23.0 days (IQR 16.0-33.0), with recurrent positive rate 25.4% in hematologic malignancy versus 10.6% in solid tumors (p = 0.02). Clearance by a predefined waiting period required 41 days until an 80% negative rate. CONCLUSIONS: COVID-19 clearance remains prolonged in oncology patients. Single-negative test clearance can balance delays in care with risk of infection in patients with solid tumors.

Immunotherapy for the treatment of multiple myeloma.

Despite advances in treatment for multiple myeloma, the majority of patients ultimately develop relapsed disease marked by immune evasion and resistance to standard therapy. Immunotherapy has emerged as a powerful tool for tumor-directed cytotoxicity with the unique potential to induce immune memory to reduce the risk of relapse. Understanding the specific mechanisms of immune dysregulation and dysfunction in advanced myeloma is critical to the development of further therapies that produce a durable response. Adoptive cellular therapy, most strikingly CAR T cell therapy, has demonstrated dramatic responses in the setting of refractory disease. Understanding the factors that contribute to immune evasion and the mechanisms of response and resistance to therapy will be critical to developing the next generation of adoptive cellular therapies, informing novel combination therapy, and determining the optimal time to incorporate immune therapy in the treatment of myeloma.

Clinical and microbiological characteristics of patients with bacteremia and normal procalcitonin.

Procalcitonin is a biomarker of bacterial infection used to guide antimicrobial therapy. However, emerging studies have highlighted bacteremic patients with low procalcitonin, potentially limiting its clinical utility. Here, we conducted an observational, retrospective study analyzing clinical and microbiological parameters of adult patients with bacteremia and procalcitonin <2 ng/mL. High proportions of patients required intensive care (31.2%) with vasopressor (14.9%) or ventilatory (17.7%) support, developed renal injury (30.7%), or had in-hospital mortality (14.4%). When divided into subgroups by procalcitonin level, patients with procalcitonin 0.5 to 2.0 ng/mL had significantly higher rates of in-hospital mortality, vasopressor requirement, and renal injury than those with procalcitonin <0.5 ng/mL. Altogether, bacteremic patients had significant morbidity and mortality despite low procalcitonin. While subgroup analysis suggested that higher procalcitonin may correlate with illness severity, a more sensitive procalcitonin cutoff did not eliminate patients with significant disease. Procalcitonin-based algorithms may not be clinically appropriate for management of bacteremia.