Convalescent plasma transfusion for immunocompromised viremic patients with COVID‐19: A retrospective multicenter study

Abstract

AbstractThis study aims to assess the safety, virological, and clinical outcomes of convalescent plasma transfusion (CPT) in immunocompromised patients hospitalized for coronavirus disease 2019 (COVID‐19). We conducted a retrospective multicenter cohort study that included all immunosuppressed patients with COVID‐19 and RNAemia from May 2020 to March 2023 treated with CPT. We included 81 patients with hematological malignancies (HM), transplants, or autoimmune diseases (69% treated with anti‐CD20). Sixty patients (74%) were vaccinated, and 14 had pre‐CPT serology >264 BAU/mL. The median delay between symptom onset and CPT was 23 days [13−31]. At D7 post‐CPT, plasma PCR was negative in 43/64 patients (67.2%), and serology became positive in 25/30 patients (82%). Post‐CPT positive serology was associated with RNAemia negativity (p < 0.001). The overall mortality rate at D28 was 26%, being higher in patients with non‐B‐cell HM (62%) than with B‐cell HM (25%) or with no HM (11%) (p = 0.02). Patients receiving anti‐CD20 without chemotherapy had the lowest mortality rate (8%). Positive RNAemia at D7 was associated with mortality at D28 in univariate analysis (HR: 3.05 [1.14−8.19]). Eight patients had adverse events, two of which were severe but transient. Our findings suggest that CPT can abolish RNAemia and ameliorate the clinical course in immunocompromised patients with COVID‐19.