Abstract
The worldwide spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated infectious coronavirus disease (COVID-19) has posed a unique challenge to medical staff, patients and their families. Patients with cancer, particularly those with haematologic malignancies, have been identified to be at high risk to develop severe COVID-19.Since publication of our previous guideline on evidence-based management of COVID-19 in patients with cancer, research efforts have continued and new relevant data has come to light, maybe most importantly in the field of vaccination studies. Therefore, an update of our guideline on several clinically important topics is warranted. Here, we provide a concise update of evidence-based recommendations for rapid diagnostics, viral shedding, vaccination and therapy of COVID-19 in patients with cancer. This guideline update was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology by critically reviewing the currently available data on these topics applying evidence-based medicine criteria.
Highlights
Rapid antigen tests are generally known to exhibit an inferior accuracy compared with nucleic acid amplification technique and are not recommended for patients with cancer [2]
Prolonged viral shedding of >100 days has been observed in immunocompromised patients with SARS-CoV-2
Detection of viral RNA does not necessarily indicate clinically relevant infectiousness, clear proof of infectiousness has been demonstrated in several cases of extremely prolonged SARS-CoV-2 shedding by viral culture or detection of subgenomic RNA [8,9,12]
Summary
Rapid antigen tests are generally known to exhibit an inferior accuracy (in particular with regard to sensitivity) compared with nucleic acid amplification technique and are not recommended for patients with cancer [2]. This applies to rapid antigen tests for SARS-CoV-2 as well because comparative studies showed a reduced sensitivity compared with the reverse transcription polymerase chain reaction (RTPCR) [3e6]. Even low viral loads are clinically relevant in patients with cancer because infectious virus has been successfully isolated from samples with Ct values >30, viral loads may be low or undetectable in throat swabs of patients presenting with lower respiratory tract involvement (LRTI), and recurrent clinical infection after viral load decrease to Ct values >30 has been reported [8e10]. In certain emergency scenarios, where prompt diagnosis of SARS-CoV-2 is required, point-of-care RT-PCR tests may offer a valuable additional option with sensitivity and specificity according to the respective manufacturer to be kept in mind
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