Convalescent plasma therapy in B-cell-depleted and B-cell sufficient patients with life-threatening COVID-19 – A case series

• Published in: Transfusion and apheresis science 2021-12, Vol.60 (6), p.103278-103278, Article 103278
• Main Authors: Erber, Johanna, Wiessner, Johannes R., Huberle, Christina, Schneider, Jochen, Mijočević, Hrvoje, von Bomhard, Doris, Luppa, Peter, Schmid, Roland M., Rasch, Sebastian, Lahmer, Tobias
• Format: Article
• Language: English
• Subjects: Adult; Aged; B-cell depletion; B-Lymphocytes; Convalescent plasma; COVID-19 - blood; COVID-19 - mortality; COVID-19 - therapy; COVID-19 Serotherapy; Disease-Free Survival; Female; Humans; Immunization, Passive; Life-threatening COVID-19; Lymphocyte Depletion; Male; Middle Aged; Retrospective Studies; SARS-CoV-2; Survival Rate
• ISSN: 1473-0502; 1878-1683; 1473-0502
• DOI: 10.1016/j.transci.2021.103278

To investigate the effect of convalescent plasma therapy (CPT) on clinical courses of B-cell-sufficient and B-cell-depleted patients with life-threatening COVID-19. In this case series, we retrospectively analysed clinical, laboratory and cardiopulmonary parameters of six patients with life-threatening COVID-19 receiving convalescent plasma (CP) as rescue therapy between April 11, 2020 to October 10, 2020. Clinical and laboratory parameters before and after transfusion were compared in two B-cell-depleted patients and four B-cell sufficient patients (control group). Both B-cell-depleted patients cleared SARS-CoV-2 virus and survived, while all other patients died within 14 days from intervention despite maximal therapeutic efforts. D-dimer levels increased in both cohorts subsequent to CPT. In control patients, mean Interleukin-6 increased and platelet levels decreased as opposed to decreasing and stable levels in B-cell-depleted patients, respectively. Control patients required increased doses of vasopressor compared to decreasing doses in B-cell depleted patients subsequent to CPT. PO2/FiO2 decrease was more pronounced and respiratory deterioration required postinterventional extracorporeal membrane oxygenation in two control patients. Transpulmonary thermodilution revealed a further increase of the Extravascular Lung Water Index upon CPT in control patients. Use of CP in late stages of life-threatening COVID-19 should be used with caution but may be beneficial in B-cell-depleted patients. Further studies are necessary to assess factors predicting potential therapeutic benefits as well as possible hazards.