High‐titer post‐vaccine COVID‐19 convalescent plasma for immunocompromised patients during the first omicron surge

Abstract

Background Transplant and hematologic malignancy patients have high Coronavirus disease 2019 (COVID‐19) mortality and impaired vaccination responses. Omicron variant evades several monoclonal antibodies previously used in immunocompromised patients. Polyclonal COVID‐19 convalescent plasma (CCP) may provide broader neutralizing capacity against new variants at high titers. Vaccination increases severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) titer in convalescent donors. Methods We conducted a retrospective chart review of hospitalized immunocompromised patients with COVID‐19 who received high‐titer CCP during the first omicron surge, collected from vaccinated donors within 6 months of pre‐omicron COVID‐19. Data on safety and outcomes were extracted. Results A total of 44 immunocompromised patients were included, 59.1% with solid organ transplant, 22.7% with hematopoietic cell transplant, 11.4% with hematologic malignancy, and 6.8% with autoimmune disease. Overall, 95% of CCP units transfused were from recently recovered and vaccinated donors and had SARS‐CoV‐2 antibody results 8‐ to 37‐fold higher than the Food and Drug Administration's cutoff for high‐titer CCP. There were two mild transfusion reactions. A total of 30‐day mortality was 4.5%. There were no differences in 100‐day mortality by underlying diagnosis, levels of immunosuppression, and timing of CCP administration. Patients with higher immunosuppression had significantly higher mean World Health Organization clinical progression scores at 30‐day post‐CCP compared to those with lower immunosuppression. Conclusions CCP is a safe, globally available treatment for immunocompromised patients with COVID‐19. Mortality was lower in our cohort than that of COVID‐19 patients with similar immunocompromising conditions. Post‐vaccine CCP with very high titers should be prioritized for study in immunocompromised patients. Post‐vaccine CCP has the potential to keep pace with new variants by overcoming mutations at sufficiently high titer.

Unveiling COVID‐19 treatment strategies for immunocompromised individuals: Therapeutic innovations and latest findings

“…22 Lindahl et al 23 In a panel of ICP make up of patients, 59.1% with solid organ transplant, 22.7% with hematopoietic cell transplant, 11.4% with hematologic malignancy, and 6.8% with autoimmune disease, neutralizing capacity against Omicron variants of CCP from recently recovered and vaccinated donors was evaluated. 24 They concluded that in the context of the Omicron era, administering high-titer post-vaccine CCP has demonstrated safety in hospitalized immunocompromised patients with COVID-19, and the 30-day mortality rate was found to be low. There is now a strong rationale for conducting randomized controlled trials to evaluate the use of post-vaccine CCP in immunocompromised patients, both as an early and late treatment option, as well as for pre-exposure prophylaxis and post-exposure prophylaxis.…”

Diminished Neutralization Capacity of SARS-CoV-2 Omicron BA.1 in Donor Plasma Collected from January to March 2021

“…Since the start of the SARS-CoV-2 pandemic, convalescent plasma was identified as a potential therapeutic candidate for clinical trials ( 4 , 5 ). Those clinical trials identified mixed efficacy of convalescent plasma and the potential for early use of high-titer convalescent plasma in immunocompromised patients infected with SARS-CoV-2 ( 6 – 10 ). A revision of the U.S. Food and Drug Administration (FDA) emergency use authorization (EUA) for the use of COVID-19 convalescent plasma identified immunocompromised individuals as clinical trial candidates for high-titer COVID-19 convalescent plasma ( 11 ).…”