Convalescent plasma therapy for B-cell-depleted patients with protracted COVID-19 #MMPMID32959052
Hueso T; Pouderoux C; Pere H; Beaumont AL; Raillon LA; Ader F; Chatenoud L; Eshagh D; Szwebel TA; Martinot M; Camou F; Crickx E; Michel M; Mahevas M; Boutboul D; Azoulay E; Joseph A; Hermine O; Rouzaud C; Faguer S; Petua P; Pommeret F; Clerc S; Planquette B; Merabet F; London J; Zeller V; Ghez D; Veyer D; Ouedrani A; Gallian P; Pacanowski J; Mekinian A; Garnier M; Pirenne F; Tiberghien P; Lacombe K
Blood 2020[Nov]; 136 (20): 2290-2295 PMID32959052show ga
Anti-CD20 monoclonal antibodies are widely used for the treatment of hematological malignancies or autoimmune disease but may be responsible for a secondary humoral deficiency. In the context of COVID-19 infection, this may prevent the elicitation of a specific SARS-CoV-2 antibody response. We report a series of 17 consecutive patients with profound B-cell lymphopenia and prolonged COVID-19 symptoms, negative immunoglobulin G (IgG)-IgM SARS-CoV-2 serology, and positive RNAemia measured by digital polymerase chain reaction who were treated with 4 units of COVID-19 convalescent plasma. Within 48 hours of transfusion, all but 1 patient experienced an improvement of clinical symptoms. The inflammatory syndrome abated within a week. Only 1 patient who needed mechanical ventilation for severe COVID-19 disease died of bacterial pneumonia. SARS-CoV-2 RNAemia decreased to below the sensitivity threshold in all 9 evaluated patients. In 3 patients, virus-specific T-cell responses were analyzed using T-cell enzyme-linked immunospot assay before convalescent plasma transfusion. All showed a maintained SARS-CoV-2 T-cell response and poor cross-response to other coronaviruses. No adverse event was reported. Convalescent plasma with anti-SARS-CoV-2 antibodies appears to be a very promising approach in the context of protracted COVID-19 symptoms in patients unable to mount a specific humoral response to SARS-CoV-2.
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Blood 2020 ; 136 (20): 2290-2295
