Charting a path forward: Promising outcomes of convalescent plasma therapy in the care of severely B‐cell depleted patients with persistent COVID‐19

Abstract

AbstractBackgroundPatients with severe B‐cell depletion related to hematological malignancies or B‐cell targeted therapy suffer from impaired antibody responses to SARS‐CoV‐2 and are at risk for prolonged COVID‐19. In this population, COVID‐19 convalescent plasma (CCP) may provide passive immunity, enhance immune response, and promote virus neutralization. This study evaluated outcomes of B‐cell depleted patients with persistent COVID‐19 treated with CCP.Study Design and MethodsThis analysis included all consecutive severely B‐cell depleted patients with persistent COVID‐19, receiving CCP at Rambam between 01.2022–02.2023. Persistent COVID‐19 was defined as the presence of symptoms for ≥14 days in patients with negative SARS‐CoV‐2 nucleocapsid antibody test results.ResultsTwenty patients met inclusion criteria, 17 of whom had hematological malignancies, two suffered from rheumatoid arthritis and one had both. Twelve patients received anti‐CD‐20 treatment, one ‐ CAR‐T cells and three underwent stem cell transplantation. The median duration of COVID‐19 symptoms was 27.5 days (range 14–97); 12 patients had mild‐to‐moderate COVID‐19 and 8 had severe infection. Sixteen patients required hospitalization. The majority of patients received other COVID‐19 therapies before CCP. Within a median of two days (range 1–16) post‐infusion, 19/20 patients clinically improved. No CCP‐associated adverse events were documented. COVID‐19 symptoms recurred in 3 of the improved patients. Two patients died from COVID‐19 on days 1 and 90 following the first CCP infusion.DiscussionIn severely B‐cell depleted patients with persistent COVID‐19, CCP is safe and associated with rapid clinical improvement. This subset of immunocompromised patients could particularly benefit from CCP administration.