Treatment of chronic COVID‐19 with convalescent/postvaccination plasma in patients with hematologic malignancies

Abstract

Immunocompromised patients are at high risk to fail clearance of SARS‐CoV‐2. Prolonged COVID‐19 constitutes a health risk and a management problem as cancer treatments often have to be disrupted. As SARS‐CoV‐2 evolves, new variants of concern have emerged that evade available monoclonal antibodies. Moreover, antiviral therapy promotes SARS‐CoV‐2 escape mutations, particularly in immunocompromised patients. These patients frequently suffer from prolonged infection. No successful treatment has been established for persistent COVID‐19 infection. Here, we report on a series of 21 immunocompromised patients with COVID‐19—most of them hematologic malignancies—treated with plasma obtained from recently convalescent or vaccinated donors or a combination thereof. Repeated dosing of SARS‐CoV‐2‐antibody‐containing plasma could clear SARS‐CoV‐2 infection in 16 out of 21 immunocompromised patients even if COVID‐19‐specific treatments failed to induce sustained viral clearance or to improve clinical course of SARS‐CoV‐2 infection. Ten patients were major responders defined as an increase delta(d)Ct of > = 5 after the first administration of convalescent and/or vaccinated plasma (C/VP). On average, SARS‐CoV‐2 PCR Ct values increased from a median value of 22.55 (IQR = 19.10–24.25) to a median value of 29.57 (IQR = 27.55–34.63; p = <.0001) in the major response subgroup. Furthermore, when treated a second time with C/VP, even 4 out of 5 of the initial nonresponders showed an increase in Ct‐values from a median value of 23.13 (IQR = 17.75–28.05) to a median value of 32.79 (IQR = 31.75–33.75; p = .013). Our results suggest that C/VP could be a feasible treatment of COVID‐19 infection in patients with hematologic malignancies who did not respond to antiviral treatment.