Immunosuppressed patients such as solid organ transplant and hematologic malignancy patients appear to be at increased risk for morbidity and mortality due to coronavirus disease 2019 (COVID‐19) caused by SARS coronavirus 2 (SARS‐CoV‐2). Convalescent plasma, a method of passive immunization that has been applied to prior viral pandemics, holds promise as a potential treatment for COVID‐19. Immunocompromised patients may experience more benefit from convalescent plasma given underlying deficits in B and T cell immunity as well as contraindications to antiviral and immunomodulatory therapy. We describe our institutional experience with four immunosuppressed patients (two kidney transplant recipients, one lung transplant recipient, and one chronic myelogenous leukemia patient) treated with COVID‐19 convalescent plasma through Expanded Access Program (NCT 04338360). All patients clinically improved after administration (two fully recovered and two discharged to skilled nursing facilities) and none experienced a transfusion reaction. We also report characteristics of convalescent plasma product from a local blood center including positive SARS‐CoV‐2 IgG and negative SARS‐CoV‐2 PCR in all samples tested. This preliminary evidence suggest that convalescent plasma may be safe among immunosuppressed patients with COVID‐19, and emphasizes the need for further data on efficacy of convalescent plasma as either primary or adjunctive therapy for COVID‐19.

Allogeneic hematopoietic stem cell transplant patients are at risk for common and atypical infections. Superior diagnostics can decrease infection-related morbidity and mortality. A novel plasma cell–free DNA next-generation sequencing test detected an uncommon presentation of Chlamydia trachomatis and recurrent and metastatic complications of Staphylococcus aureus bacteremia before standard microbiology.

Objectives: Immunomodulatory drugs (IMDs) are crucial for treating autoimmune, inflammatory, and oncologic conditions. Data regarding the safety of IMDs in people living with HIV (PLWH) are limited. We describe outcomes in all PLWH prescribed these agents from 2000--2019 at two academic medical centers. Design: Retrospective cohort study. Methods: We systematically identified and reviewed charts of all PLWH receiving IMDs. We defined a treatment episode as an uninterrupted period on an IMD regimen. We quantified infections, blips (detectable plasma HIV RNA following an undetectable result), and virologic failure (progression from plasma HIV RNA <200 copies/ml to two consecutive values >200 copies/ml despite ART). Results: Seventy-seven patients contributed 110 treatment episodes. Rheumatologic comorbidities were the most frequent indication. The most common IMD classes were TNF inhibitors, antimetabolites, and checkpoint inhibitors. Ninety percent of treatment episodes involved concomitant ART. Median pretreatment CD4+ T-cell count was 609 cells/μl (IQR 375--861). Among 51 treatment episodes on ART with undetectable pretreatment plasma HIV RNA, HIV became detectable within 1 year in 21 of 51 cases (41.2%); there were no instances of virologic failure. Compared with other agents, treatment episodes involving checkpoint inhibitors were more likely to involve a blip (77.8 vs. 33.3%, P = 0.015). Thirteen treatment episodes (11.8%) were associated with concomitant infection; none was attributed to IMDs by the treating clinician. Conclusion: PLWH treated with IMDs should be monitored carefully for virologic blips and incident infections. Checkpoint inhibitors may be associated with a higher rate of viral blips, although the clinical significance is unclear.

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eight long-answer questions, four yes/no questions, and three checkbox questions focused on IgG measurement and HG treatment practices pre-and post-lung transplant. We sent the survey to 50 physicians at 40 transplant centers internationally using Google Forms on February 4 th , 2020. Results: There were 24 (48%, 24/50) respondents from 19 lung transplant centers. Responses were tabulated for individual respondents as answers varied within centers. Respondents reported routinely measuring IgG levels in 54% (13/24) of pre-transplant patients and 38% (9/24) of post-transplant patients, with time points for checking IgG levels varying widely. In post-transplant patients with frequent infections, respondents reported routinely measuring IgG levels (83%, 20/24), routinely not measuring (13%, 3/24), or not having a protocol (4%, 1/24). Reported criteria for initiating IgG replacement therapy (IgG-RT) were infection frequency only (n=2), IgG level only (n=6), or some combination of the two (n=9). IgG level cutoffs utilized to initiate IgG-RT ranged from <300 mg/dL to <600 mg/dL. Despite 41% (9/22) of respondents reporting they did not feel HG patients were being successfully identified and treated, 50% (11/22) reported patients were never referred to allergy/immunology. Reported barriers to screening and management centered around insurance-related issues (32%, 7/22), IgG-RT shortages (14%, 3/22), and distribution issues (14%, 3/22), and lack of evidence-based treatment protocols (32%, 7/22). Conclusion: HG screening and management practices in lung transplant recipients vary greatly, potentially leaving patients vulnerable to worse clinical outcomes. Reported barriers include lack of guidance regarding HG treatment criteria and difficulties obtaining IgG-RT. Involving immunologists in screening and treatment decision-making could mitigate some of these barriers.