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Convalescent plasma therapy for B-cell–depleted patients with protracted COVID-19

2020; Elsevier BV; Volume: 136; Issue: 20 Linguagem: Inglês

10.1182/blood.2020008423

1528-0020

Thomas Hueso, Cécile Pouderoux, Hélène Péré, Anne-Lise Beaumont, Laure-Anne Raillon, Florence Ader, Lucienne Chatenoud, Déborah Eshagh, Tali‐Anne Szwebel, M. Martinot, Fabrice Camou, Étienne Crickx, Marc Michel, Matthieu Mahévas, David Boutboul, Élie Azoulay, Adrien Joseph, Olivier Hermine, Claire Rouzaud, Stanislas Faguer, Philippe Petua, Fanny Pommeret, Sébastien Clerc, Benjamin Planquette, Fatiha Merabet, Jonathan London, Valérie Zeller, David Ghez, David Veyer, Amani Ouedrani, Pierre Gallian, Jérôme Pacanowski, A. Mékinian, Marc Garnier, France Pirenne, Pierre Tiberghien, Karine Lacombe,

SARS-CoV-2 and COVID-19 Research

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.