No abstract

The effectiveness of COVID-19 vaccination remains unknown in patients with hematologic malignant disease who have an impaired humoral immunity from both treatment and disease. Phase 3 registration studies of COVID-19 vaccines excluded patients with immunosuppression or immunosuppressive therapies. 1,2 Despite this, professional organizations suggest vaccination, or even its prioritization, for patients with cancer. 3 As the US Centers for Disease Control loosens pandemic-related precautions for vaccinated people, a better understanding of the vaccine response among patients with hematologic malignant disease is critical.

Background The efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear. Methods In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis. Results 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (p = 0.52). There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 – 2.20). The overall rate of hospital discharge was not significantly different between the two groups (rate ratio [RR] 1.28, 95% CI 0.91 – 1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03 – 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). Conclusions We did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.