Use of convalescent plasma inCOVID‐19 patients with immunosuppression

Abstract

In the absence of effective countermeasures, human convalescent plasma has been widely used to treat severe acute respiratory syndrome coronavirus 2, the causative agent of novel coronavirus disease 19 (COVID‐19), including among patients with innate or acquired immunosuppression. However, the association between COVID‐19‐associated mortality in patients with immunosuppression and therapeutic use of convalescent plasma is unknown. We review 75 reports, including one large matched‐control registry study of 143 COVID‐19 patients with hematological malignancies, and 51 case reports and 23 case series representing 238 COVID‐19 patients with immunosuppression. We review clinical features and treatment protocols of COVID‐19 patients with immunosuppression after treatment with human convalescent plasma. We also discuss the time course and clinical features of recovery. The available data from case reports and case series provide evidence suggesting a mortality benefit and rapid clinical improvement in patients with several forms of immunosuppression following COVID‐19 convalescent plasma transfusion. The utility of convalescent plasma or other forms of antibody therapy in immune‐deficient and immune‐suppressed patients with COVID‐19 warrants further investigation.

Coagulation profile of human COVID-19 convalescent plasma

“…These trials often provided convalescent plasma to patients late in the disease stage 20,21 or used plasma with a low antibody titer 21 . Subanalyses from these trials 23 and data from large observational studies have highlighted that use of high-titer [24][25][26] convalescent plasma in patients with low endogenous antibody levels, either because they are early in the disease course [25][26][27] or because they are immunodeficient 28 , may provide a survival benefit 29 . Regardless, due to the widespread availability of convalescent plasma compared to other novel therapies, it is plausible that convalescent plasma may continue to be used to treat COVID-19 infection, particularly in resource poor locations 30 .…”

Serology-based therapeutic strategy in SARS-CoV-2-infected patients

“…The median number of days from diagnosis to convalescent plasma infusion was four (range 1-9 days) and patients remained hospitalized in the COVID-19 infection ward a median of eight days (range 1-29 days). A recent review indicates that mortality of patients with immunosuppression who were treated with convalescent plasma was 16%, with 60% of patients demonstrating rapid clinical improvement within 5 days after convalescent plasma therapy [19] . Other studies reporting on the success of plasma when transfused within 3 days support our strategy and findings [20] , [21] .…”

COVID-19 Advanced Care

“…However, a meta-analysis of randomized trials mainly including inpatients (more than 10,000) proved no impact of CP in COVID-19 outcomes [85]. In addition, weak observational evidence indicating that CP may be beneficial for patients with impaired humoral immunity [86][87][88][89][90][91][92][93][94][95] requires appropriate clinical testing. Based on the above, in February 2021, the revised FDA EUA limited the authorization to high-titer CP only for the treatment of hospitalized COVID-19 patients early in the disease course with impaired humoral immunity [75].…”