Background/Case Studies: SARS-CoV-2 infection in immunosuppressed patients has a worse prognosis and it is often associated with persistent infection that can lead to an oncoespecific therapy delay. Various case series have been published where treatment with convalescent plasma (CCP) is associated with a rapid clinical improvement and a decreased mortality. As new SARS-CoV-2 variants emerge, available treatment options such as monoclonal antibody become ineffective. Therefore, CCP could represent a treatment option in such scenario. In this context, we report a case series of immunocompromised patients treated with CCP in a tertiary care hospital.
Study
Design/Methods: A retrospective study was carried out in a single center. All patients over 18 years-old, diagnosed with a mild or moderate COVID-19, and treated with CCP from January 2021 to April 2023 were included. Demographic variables, clinical history, and SARS-CoV-2 infection characteristics were studied. Plasma units were obtained from SARS-CoV-2 vaccinated convalescent donors with titers >2840 BAU/mL. In persistent COVID-19 patients, we used a 21 days serial CCP administration until clinical response or a negative PCR was obtained.
Results/Findings: A total of 53 consecutive patients were included in the analysis. Median age was 69 years-old (range, 37-91) and 54.7% were women. 42 cases (79.2%) had a hematological malignancy history and anti-CD20 therapy had previously been administered in 46 (86.8%). At the time of COVID-19 diagnosis, 38 patients (71.7%) presented lymphopenia and 39 cases, (73.6%) hypogammaglobulinemia. Other patient’s characteristics are provided in table 1. With regard to COVID-19, 31 cases (58.5%) showed persistent infection, 16 patients (30.2%) received several administrations of CCP, and 41 cases (77.3%) obtained a negative PCR after CCP administration. 43 of the cases (81.1%) presented clinical improvement 30 days after administration of CCP and 6 patients (11.3%) died due to COVID-19. In 16 of the 33 cases with oncohematological active disease, treatment had to be delayed because of SARS-CoV2 infection. Subsequent medical approach, including CCP, allowed for the resumption of the base pathology treatment due to obtaining a negative PCR in 13 patients. No adverse events were detected. Conclusions: Our data suggest that CCP transfusion is safe and may enhance clinical improvement in immunosuppressed patients, with especial interest in a persistent COVID-19 setting. Further prospective studies are necessary to assess the real impact of this treatment in this patient subgroup.
Importance of research: SARS-CoV-2 infection in immunocompromised patients is challenging, and prolonged viral shedding can be a common complication. This may lead to cancer treatment delay with prognostic implications. Here, we described a mild-moderate COVID-19 immunosuppressed patient’s cohort with a high proportion of persistent infection where serial vaccine-boosted convalescent plasma treatment could contribute to negative PCR achievement and clinical improvement.
