Use of Convalescent/ Post-Vaccination Plasma in Immunosuppressed Patients with Persistent Sars-Cov-2 Infection

Abstract

Introduction and objectives: Immunosuppressed patients are especially vulnerable to persistent SARS-CoV-2 infection. Passive immunotherapy with convalescent or post-vaccination plasma has been recommended in these patients in order to eradicate the virus. In this paper we describe the results of treatment with convalescent/ post-vaccination plasma (PC-PVP) in immunosuppressed patients with persistent COVID-19 seen in our center. Methods and patients: Clinical and transfusion data were retrospectively collected for 37 immunosuppressed patients with persistent COVID-19 (PCR positive at least one month) who required admission and administration of PC-PVP between March 2020 and January 2022. All patients received at least 2 units of PC-PVP with an antibody titer higher than 3 S/CO (Euroimmun Medizinische Labordiagnostika, Lübeck, Germany). From June 2021, convalescent plasma was replaced with post-vaccination plasma from male donors with past COVID-19 who had received at least one dose of anti-SARS-CoV-2 vaccine. Results: Table 1 summarizes the main characteristics of the cohort. All patients had any comorbidity at admission. Seventy-three percent had a hematologic malignancy and most were receiving immunosuppressive therapy (70%). In 23 patients it was necessary to delay treatment of the underlying disease due to persistent COVID-19. Thirty percent of patients required two or more hospital admissions, 46% were admitted to the ICU and 24% required orotracheal intubation at some point. Twenty-two percent of patients had received at least one dose of SARS-CoV-2 vaccine. Sixteen patients received a transfusion of 2 units of PC-PPV and twenty-one received 4 or more units. The median anti-SARS-CoV-2 titer in PC-PVP units was 8.61 S/CO (inter-quartile range: 6.84-9.51). One patient presented a severe transfusion reaction in the form of non-cardiogenic pulmonary edema. Twenty of the thirty-seven patients managed to eradicate the virus (54%). Seven patients died as a consequence of their underlying disease and three due to complications derived from COVID-19. All patients who were PCR negative are still alive (p < 0.001). Conclusion: PC-PVP is successful in eradicating SARS-Cov2 in immunosuppressed patients with persistent COVID-19, which may translate into improved survival. Larger studies are needed to define the role of this therapeutic.