Fig. 1: Prolonged duration of SARS-CoV-2 RNA shedding correlated with high viral load and COVID-19 severity in patients with cancer.

A Graphical schema of cohorts and patients’ accrual. B Proportion of patients with cancer from translational research (TR) (Cancer_FR1_TR, n = 35, magenta area) or healthcare workers (HCW, n = 45, blue area) by days of RT-qPCR positivity. Vertical dashed line at 40 days represents the 95th percentile of HCW and the median of positivity of patients with cancer. C Kaplan–Meier curves of time to negative RT-qPCR in HCW (n = 45, blue dotted lines) and patients with cancer (Cancer_FR1_TR, n = 35, magenta continuous lines). D COVID-19⁺ cancer-bearing or history of cancer (+) and cancer-free (−) individuals from FR2 treated with hydroxychloroquine +/− azithromycin: number (percentages) of patients with RT-qPCR positivity beyond 16 days (90th percentile of the cancer-free population of FR2). E Number (percentages) of HCW, Cancer_FR1 patients (Cancer_FR1_TR), or Canadian patients with cancer (Cancer_CA) with short, intermediate (grouped in short-term viral RNA shedding, SVS), and prolonged (long-term viral RNA shedding, LVS) viral RNA shedding (E), according to the presence/absence of viral symptoms (symptomatic, Sym, vs asymptomatic, Asym) (F), diagnosis of hematological (H) versus solid (S) malignancy (G), and cancer staging (localized (L), locally advanced (LA), metastatic (M)) (H). I Number (percentages) of Cancer_FR1 patients (from translational research and clinical routine), Cancer_FR2 patients (Cancer_FR2) or Canadian patients with cancer (Cancer_CA) divided in SVS and LVS and regarding their respective COVID-19 severity. J Spearman correlation between Cycle threshold (Ct) for the RT-qPCR amplification of genes encoding proteins of SARS-CoV-2 replication–transcription complex at diagnosis and duration of RT-qPCR positivity for Cancer_FR1 (from translational research and clinical routine), each dot representing one sample/patient. K Ct values for the RT-qPCR amplification of genes encoding proteins of SARS-CoV-2 replication–transcription complex in nasopharyngeal swabs performed at diagnosis in SVS versus LVS in Cancer_FR1_TR and CR and Cancer_FR2, and dynamics over time from day 0 up to day 80 after inclusion in SVS (n = 33 samples, n = 28 patients, orange dots) versus LVS (57 samples, n = 17 patients, purple dots) in Cancer_FR1 (from translational research and clinical routine). L Redundancy statistical analysis (RDA) of cancer and viral related-clinical factors accounting for the variance of SARS-CoV-2 viral shedding status. Clinical components were influenced by the virus shedding (SVS versus COVID-19-negative, P = 0.037; LVS versus COVID-19 negative, P = 0.0010), COVID severity (mild versus COVID-19-negative, P = 0.0030; moderate versus COVID-19-negative, P = 0.0574; severe versus COVID-19-negative, P not computable), age (P = 0.0514), hematological rather than solid malignancy (hematological versus solid, P = 0.001), metastatic status (P = 0.0059), and Ct values at diagnosis (≥25 versus < 25, P = 0.0738). Chi-square tests with *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001.