Convalescent plasma treatment in severely immunosuppressed patients hospitalized with COVID-19: an observational study of 28 cases

Abstract

Background Immunosuppressed patients are particularly vulnerable to severe infection from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), risking prolonged viremia and symptom duration. In this study we describe clinical and virological treatment outcomes in a heterogeneous group of patients with severe immunosuppression due to various causes suffering from COVID-19 infection, who were all treated with convalescent plasma (CCP) along with standard treatment. Methods We performed an observational, retrospective case series between May 2020 to March 2021 at three sites in Skåne, Sweden, with a population of nearly 1.4 million people. All patients hospitalized for COVID-19 who received CCP with the indication severe immunosuppression as defined by the treating physician were included in the study ( n = 28). Results In total, 28 severely immunocompromised patients, half of which previously had been treated with rituximab, who had received in-hospital convalescent plasma treatment of COVID-19 were identified. One week after CCP treatment, 13 of 28 (46%) patients had improved clinically defined as a decrease of at least one point at the WHO-scale. Three patients had increased score points of whom two had died. For 12 patients, the WHO-scale was unchanged. Conclusion As one of only few studies on CCP treatment of COVID-19 in hospitalized patients with severe immunosuppression, this study adds descriptive data. The study design prohibits conclusions on safety and efficacy, and the results should be interpreted with caution. Prospective, randomized trials are needed to investigate this further.

Antibody response and intra-host viral evolution after plasma therapy in COVID-19 patients pre-exposed or not to B-cell depleting agents

“…The usefulness of plasma therapy is more substantial in immunodeficient patients. There is growing evidence from cohort studies and case-series, that CP therapy in frail immunosuppressed individuals, unable to mount effective anti-SARS-CoV-2 antibody responses, reduces viral load and improves clinical symptoms, even when given late after initial diagnosis (20)(21)(22)(23)(24)(25). Accordingly, these findings suggest that the administration of plasma with high neutralizing antibody titers is a safe and effective treatment for immunosuppressed patients (3,26,27).…”

Persistently positive PCR SARS-CoV-2 at low cycle threshold in an immunosuppressed patient

“…Studies and reports have been published with different treatments, including several monoclonal antibodies, 5 immunoglobulins, remdesivir and convalescent plasma, 6 but few of them focused in immunosuppressed patients with prolonged disease courses 7 , 8 with diverse results. Although these treatments were considered, they were not prescribed on first attempt, mainly due to non-availability, difficulty in prescribing them as they were not included in the protocols and expected procoagulability.…”

The Fc-effector function of COVID-19 convalescent plasma contributes to SARS-CoV-2 treatment efficacy in mice

“…The use of CP therapy dates back to the 1918 influenza pandemic and more recently to fight outbreaks caused by SARS-CoV-1, MERS and Ebola (Cao and Shi, 2020; Luke et al, 2006; Mair-Jenkins et al, 2015). CP therapy may be of particular interest for the aged and immune-suppressed cancer or transplant patients where vaccination fails to elicit protective antibody responses as well as in co-morbid populations where vaccination cannot be used (Beraud et al, 2022; Ljungquist et al, 2022; Pinkus and Said, 1986). Unlike with vaccines and monoclonal antibodies (mAbs), CP therapy requires limited development and standard infrastructure for blood collection and is rapidly deployable globally even under low resource settings.…”