Treatment of COVID-19 with convalescent plasma in patients with humoral immunodeficiency – Three consecutive cases and review of the literature

Abstract

Patients lacking humoral response have been suggested to develop a less severe COVID-19, but there are some reports with a prolonged, relapsing or deadly course. From April 2020, there is growing evidence on the benefits of COVID-19 convalescent plasma (CCP) for patients with humoral immunodeficiency. Most of them had a congenital primary immunodeficiency or were on treatment with anti CD20 antibodies. We report on three patients treated in our hospital and review thirty-one more cases described in the literature. All patients but three resolved clinical picture with CCP. A dose from 200 to 800 ml was enough in most cases. Antibody levels after transfusion were negative or low, suggesting consumption of them in SARS-CoV-2 neutralization. These patients have a protracted clinical course shortened after CCP. CCP could be helpful for patients with humoral immunodeficiency. It avoid relapses and chronification. CCP should be transfused as early as possible in patients with COVID-19 and humoral immunodeficiency.

Coronavirus disease 2019 in patients with inborn errors of immunity: lessons learned

“…Early therapy with type I interferon has also been attempted in several patients, although the timing of this treatment is challenging [ 100 ▪ , 101 , 102 ]. Caution should be used with regard to convalescent plasma, which has been successfully administered to several patients with IEIs and prolonged COVID-19, but has also been found to harbor antitype I interferon autoantibodies [ 27 , 33 , 39 , 42 , 45 , 48 , 49 , 76 ]. Therapeutic plasma exchange could be beneficial to remove deleterious autoantibodies and proinflammatory cytokines in critical patients, and it has been attempted with anecdotal positive results [ 100 ▪ , 103 – 105 ].…”

“…Reflecting the relative frequency of humoral immunodeficiencies among IEIs, the majority of patients who experienced COVID-19 are affected by antibody deficiency ( n = 330, 51%) [ 5 ▪ , 9 ▪ , 10 , 12 – 17 , 19 , 24 , 26 , 28 , 30 , 33 , 34 , 36 , 37 , 42 , 44 , 45 , 48 , 52 , 53 , 55 , 57 – 62 , 64 , 66 – 69 ]. Among them, 200 have common variable immunodeficiency (CVID, 60% of all antibody deficiencies), 59 have X-linked agammaglobulinemia (XLA, 18%) and eight have autosomal recessive agammaglobulinemia (2%).…”

Lessons learned from the use of convalescent plasma for the treatment of COVID-19 and specific considerations for immunocompromised patients

“…During screening 2, which was performed to identify studies evaluating the potential benefit of CovCP in immunocompromised patients with COVID-19, nine articles were selected (one matched case-control study [43], one non-matched case-control series [57], and seven uncontrolled case series [58][59][60][61][62][63][64]) (Table 2). All the selected articles were categorized as Oxford LoE 4 or 5.…”

Use of convalescent plasma inCOVID‐19 patients with immunosuppression

“…Many treatments of hematologic malignancies, such as the cornerstone of treatment (anti‐CD‐20 monoclonal antibodies), may lead to prolonged B‐cell depletion and impaired immune responses 43,44 . From 32 case reports 45–76 and 11 case series, 27,44,77–85 we identified 150 COVID‐19 patients with hematological malignancies treated with convalescent plasma. Among these 150 patients, the mortality rate was 20% (30 of 150 patients), 37 patients demonstrated rapid clinical improvement after convalescent plasma transfusion, and the average time between convalescent plasma transfusion and hospital discharge was 27 days.…”