Case Series: Convalescent Plasma Therapy for Patients with COVID-19 and Primary Antibody Deficiency

Springer Science and Business Media LLC - Tập 42 - Trang 253-265 - 2021
Julia Lang-Meli1, Jonas Fuchs2, Philipp Mathé3, Hsi-en Ho4, Lisa Kern2, Lena Jaki2, Giuseppe Rusignuolo1, Susanne Mertins3, Vivien Somogyi5, Christoph Neumann-Haefelin1, Frederik Trinkmann5,6, Michael Müller5, Robert Thimme1, Markus Umhau7, Isabella Quinti8, Dirk Wagner3, Marcus Panning2, Charlotte Cunningham-Rundles4,9, Katharina Laubner1, Klaus Warnatz10,11
1Department of Medicine II, Medical Center – University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
2Institute of Virology, University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
3Division of Infectious Diseases, Department of Medicine II, Medical Center – University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
4Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
5Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Enter Heidelberg, German Center for Lung Research, Heidelberg, Germany
6Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health (CPD-BW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
7Institute for Transfusion Medicine and Gene Therapy, University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
8Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
9Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
10Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
11Center for Chronic Immunodeficiency, Medical Center – University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany

Tóm tắt

Patients with primary antibody deficiency are at risk for severe and in many cases for prolonged COVID-19. Convalescent plasma treatment of immunocompromised individuals could be an option especially in countries with limited access to monoclonal antibody therapies. While studies in immunocompetent COVID19 patients have demonstrated only a limited benefit, evidence for the safety, timing, and effectiveness of this treatment in antibody-deficient patients is lacking. Here, we describe 16 cases with primary antibody deficiency treated with convalescent plasma in four medical centers. In our cohort, treatment was associated with a reduction in viral load and improvement of clinical symptoms, even when applied over a week after onset of infection. There were no relevant side effects besides a short-term fever reaction in one patient. Longitudinal full-genome sequencing revealed the emergence of mutations in the viral genome, potentially conferring an antibody escape in one patient with persistent viral RNA shedding upon plasma treatment. However, he resolved the infection after a second course of plasma treatment. Thus, our data suggest a therapeutic benefit of convalescent plasma treatment in patients with primary antibody deficiency even months after infection. While it appears to be safe, PCR follow-up for SARS-CoV-2 is advisable and early re-treatment might be considered in patients with persistent viral shedding.

Tài liệu tham khảo

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Springer Science and Business Media LLC

Tập 42

253-265

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