Convalescent plasma therapy and COVID-19

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


Visual abstract

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Key Points

  • As a proof of concept, COVID-19 convalescent plasma represents an interesting approach in B-cell–depleted patients with protracted COVID-19.
  • COVID-19 convalescent plasma induces a decrease in temperature and inflammatory parameters within 1 week associated with oxygen weaning.

Results

Images of some results obtained

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Individual longitudinal evolution before and after CPT

Description of the Study:

  • Title: Convalescent plasma therapy for B-cell–depleted patients with protracted COVID-19
  • Principal Investigators: Thomas Hueso, Cécile Pouderoux, Hélène Péré, Anne-Lise Beaumont, Laure-Anne Raillon, Florence Ader, Lucienne Chatenoud, Déborah Eshagh, Tali-Anne Szwebel, Martin Martinot, Fabrice Camou, Etienne Crickx, Marc Michel, Matthieu Mahevas, David Boutboul, Elie 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, Arsène Mékinian, Marc Garnier, France Pirenne, Pierre Tiberghien and Karine Lacombe.
  • Centers of Implementation: Multicenter study conducted in 13 French hospitals from 1 May 2020 to 30 June 2020.
  • Study Population: All patients presenting with a B-cell immunodeficiency and prolonged COVID-19 symptoms, confirmed by SARS-CoV-2–specific reverse transcription polymerase chain reaction (RT-PCR) in respiratory samples and without seroconversion, were eligible for CPT.
  • Study Type: Observational and multicenter study.
  • Design: Each patient received 2 consecutive transfusions of 2 ABO-compatible convalescent plasma units (200-220 mL each) at days 0 and +1. Clinical parameters (temperature and oxygen need) were collected daily from day +5 before to day +7 after the last plasma transfusion. Biological parameters, including inflammatory markers (C-reactive protein [CRP], ferritin) and circulating lymphocyte subpopulations, were also assessed. When available, plasma interleukin-6 (IL-6) was quantified in a subset of patients who did not receive tocilizumab.
  • Methods: The severity of COVID-19 disease was evaluated using the World Health Organization classification.
    SARS-CoV-2 serology was performed using the IgG enzyme-linked immunosorbent assays in use in the different hospitals.16 SARS-CoV-2 RNAemia was quantified using droplet-based digital RT-PCR (ddPCR) technology, based on a COVID-19 Multiplex Crystal Digital PCR detection kit.
    Virus-specific T-cell responses were analyzed before CPT in peripheral blood mononuclear cells using an interferon-γ (IFN-γ) enzyme-linked immunospot assay after the addition of individual 15-mers 11-aa overlapping peptide pools of different SARS-CoV-2 proteins or of common coronavirus proteins.

Objectives of the Study:

Principal Objective: To assess the safety and efficacy of CPT in 17 patients with profound B-cell lymphopenia and protracted COVID-19 disease.


More about this Study:

Scientific context: Anti-CD20 monoclonal antibodies (MoAbs), such as rituximab, represent the cornerstone of treatment for most patients with B-cell malignancies and, to a lesser extent, patients with autoimmune disease. Repeated administrations of rituximab may lead to prolonged B-cell depletion, which impairs the adaptive immune response and the ability to produce neutralizing antibodies. Patients with hematological malignancies or autoimmune diseases may be at higher risk for severe forms of COVID-19. Those patients are often excluded from clinical trials testing COVID-19 drugs and urgently need therapeutic options.

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