Welcome to Francis Academic Press

Frontiers in Medical Science Research, 2024, 6(2); doi: 10.25236/FMSR.2024.060202.

Impaired T-cell Reactivity in Hematological Malignancy Patients: Insights into SARS-CoV-2 Omicron Infection and Clinical Implications


Xiaodan Luo1, Ao Chen1, Xian Long2, Liang Peng2, Jianli Tang1, Jianbo Liu1, Jiayu Huang1, Lian Liu1, Huo Tan1, Runhui Zheng1

Corresponding Author:
Runhui Zheng

1Hematology Department, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China

2Department of Laboratory Medicine, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China


The SARS-CoV-2 Omicron variant has posed global health challenges, particularly for individuals with haematological malignancies. This study aimed to characterize clinical and immunological aspects of Omicron-infected haematological malignancy patients and compare them to the general population. In a retrospective study from Dec 3, 2022, to Apr 30, 2023, we assessed SARS-CoV-2-positive patients in the Haematology Department (study group) and randomly selected control patients from other departments. Clinical symptoms were similar, but pneumonia was more common in the patients with haematological malignancies. Haemoglobin and platelet levels were notably lower in the study group, and they had a higher viral load with lower intracellular ATP levels in CD4+ and CD8+ T cells. CD8+ ATP levels were further reduced in lymphocytic malignancies. Risk factors for mortality included age >60 years, ECOG score >3, CRP >50 mg/L, and NLR ≥6.5. This study emphasizes the significance of cellular immune responses in Omicron-infected haematological malignancy patients. Tailored clinical strategies and close monitoring are crucial for this vulnerable group due to potential immune impairments and associated risks.


Omicron, Haematological Malignancy, T-cell Reactivity, ATP

Cite This Paper

Xiaodan Luo, Ao Chen, Xian Long, Liang Peng, Jianli Tang, Jianbo Liu, Jiayu Huang, Lian Liu, Huo Tan, Runhui Zheng. Impaired T-cell Reactivity in Hematological Malignancy Patients: Insights into SARS-CoV-2 Omicron Infection and Clinical Implications. Frontiers in Medical Science Research (2024), Vol. 6, Issue 2: 10-16. https://doi.org/10.25236/FMSR.2024.060202.


[1] Malard F, Genthon A, Brissot E, van de Wyngaert Z, Marjanovic Z, Ikhlef S, et al. COVID-19 outcomes in patients with hematologic disease. Bone Marrow Transplant. 2020;55(11):2180-2184.

[2] Martin-Moro F, Marquet J, Piris M, Michael BM, Saez AJ, Corona M, et al. Survival study of hospitalised patients with concurrent COVID-19 and haematological malignancies. Br J Haematol. 2020; 190(1):e16-e20.

[3] Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, et al. Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discov. 2020;10(7):935-941.

[4] Scarfo L, Chatzikonstantinou T, Rigolin GM, Quaresmini G, Motta M, Vitale C, et al. COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus. Leukemia. 2020;34(9):2354-2363.

[5] Dhama K, Nainu F, Frediansyah A, Yatoo MI, Mohapatra RK, Chakraborty S, et al. Global emerging Omicron variant of SARS-CoV-2: Impacts, challenges and strategies. J Infect Public Health. 2023; 16(1):4-14.

[6] Lauring AS, Tenforde MW, Chappell JD, Gaglani M, Ginde AA, McNeal T, et al. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study. BMJ. 2022;376:e069761.

[7] Geng Y, Fan Y, Deng X, Wang Y, Zhao J, Ji L, et al. The Recent Outbreak of COVID-19 in China During the Omicron Variant Predominance: Clinical Features and Outcomes in Patients with Autoimmune Inflammatory Rheumatic Diseases. Rheumatol Ther. 2023;10(4):1039-1053.

[8] Fung M, Babik JM. COVID-19 in Immunocompromised Hosts: What We Know So Far. Clin Infect Dis. 2021; 72(2):340-350.

[9] Goldman JD, Robinson PC, Uldrick TS, Ljungman P. COVID-19 in immunocompromised populations: implications for prognosis and repurposing of immunotherapies. J Immunother Cancer. 2021; 9(6).

[10] Liu C, Zhao Y, Okwan-Duodu D, Basho R, Cui X. COVID-19 in cancer patients: risk, clinical features, and management. Cancer Biol Med. 2020;17(3):519-527.

[11] Nunn AVW, Guy GW, Botchway SW, Bell JD. SARS-CoV-2 and EBV; the cost of a second mitochondrial "whammy"? Immun Ageing. 2021;18(1):40.

[12] Pinana JL, Martino R, Garcia-Garcia I, Parody R, Morales MD, Benzo G, et al. Risk factors and outcome of COVID-19 in patients with hematological malignancies. Exp Hematol Oncol. 2020;9:21.

[13] Tizazu AM, Mengist HM, Demeke G. Aging, inflammaging and immunosenescence as risk factors of severe COVID-19. Immun Ageing. 2022;19(1):53.

[14] Bhaskar S, Sinha A, Banach M, Mittoo S, Weissert R, Kass JS, et al. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Front Immunol. 2020;11:1648.

[15] England JT, Abdulla A, Biggs CM, Lee AYY, Hay KA, Hoiland RL, et al. Weathering the COVID-19 storm: Lessons from hematologic cytokine syndromes. Blood Rev. 2020:100707.

[16] Mangalmurti N, Hunter CA. Cytokine Storms: Understanding COVID-19. Immunity. 2020; 53(1): 19-25.

[17] Moss P. The T cell immune response against SARS-CoV-2. Nat Immunol. 2022;23(2):186-193.

[18] Picchianti Diamanti A, Rosado MM, Pioli C, Sesti G, Lagana B. Cytokine Release Syndrome in COVID-19 Patients, A New Scenario for an Old Concern: The Fragile Balance between Infections and Autoimmunity. Int J Mol Sci. 2020;21(9).

[19] Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-655.

[20] Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2020;24(1):647.

[21] Webster HH, Nyberg T, Sinnathamby MA, Aziz NA, Ferguson N, Seghezzo G, et al. Hospitalisation and mortality risk of SARS-COV-2 variant omicron sub-lineage BA.2 compared to BA.1 in England. Nat Commun. 2022; 13(1):6053.

[22] Meng Y, Lu W, Guo E, Liu J, Yang B, Wu P, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis. J Hematol Oncol. 2020; 13(1):75.

[23] Zhu XY, Lu YF, Xue F, Luo Y, Feng MX, Qiu BJ, et al. SARS-CoV-2 BA.2 (Omicron) variant infection in pediatric liver transplanted recipients and cohabitants during 2022 Shanghai outbreak: a prospective cohort. Virol J. 2023;20(1):28.

[24] Garassino MC, Whisenant JG, Huang LC, Trama A, Torri V, Agustoni F, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020;21(7):914-922.

[25] Pinato DJ, Aguilar-Company J, Ferrante D, Hanbury G, Bower M, Salazar R, et al. Outcomes of the SARS-CoV-2 omicron (B.1.1.529) variant outbreak among vaccinated and unvaccinated patients with cancer in Europe: results from the retrospective, multicentre, OnCovid registry study. Lancet Oncol. 2022; 23(7):865-875.

[26] da Silva Antunes R, Pallikkuth S, Williams E, Dawen Yu E, Mateus J, Quiambao L, et al. Differential T-Cell Reactivity to Endemic Coronaviruses and SARS-CoV-2 in Community and Health Care Workers. J Infect Dis. 2021;224(1):70-80.

[27] Sekine T, Perez-Potti A, Rivera-Ballesteros O, Stralin K, Gorin JB, Olsson A, et al. Robust T Cell Immunity in Convalescent Individuals with Asymptomatic or Mild COVID-19. Cell. 2020;183(1):158-168 e14.

[28] Jo Y, Lim J, Kim Y, Han K, Min WS, Oh EJ. CD4 T-cell function assay using Cylex ImmuKnow and lymphocyte subset recovery following allogeneic hematopoietic stem cell transplantation. Transpl Immunol. 2015;33(2):78-83.

[29] Ogonek J, Kralj Juric M, Ghimire S, Varanasi PR, Holler E, Greinix H, et al. Immune Reconstitution after Allogeneic Hematopoietic Stem Cell Transplantation. Front Immunol. 2016;7:507.

[30] Zeevi A, Lunz J. Cylex ImmuKnow Cell Function Assay. Methods Mol Biol. 2013;1034:343-351.

[31] Notarbartolo S, Ranzani V, Bandera A, Gruarin P, Bevilacqua V, Putignano AR, et al. Integrated longitudinal immunophenotypic, transcriptional and repertoire analyses delineate immune responses in COVID-19 patients. Sci Immunol. 2021;6(62).