Treatment of chronic COVID‐19 with convalescent/postvaccination plasma in patients with hematologic malignancies

• Published in: International journal of cancer Vol. 155; no. 4; pp. 618 - 626
• Main Authors: Janssen, Maike, Leo, Albrecht, Wolf, Cornelia, Stenzinger, Miriam, Bartenschlager, Marie, Brandt, Juliane, Sauer, Sandra, Schmitt, Michael, Dreger, Peter, Schlenk, Richard F., Denkinger, Claudia M., Müller‐Tidow, Carsten
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15.08.2024; Wiley Subscription Services, Inc
• Subjects: Antiviral agents; Blood cancer; Cancer therapies; COVID-19; COVID-19 vaccines; Immunocompromised hosts; Infections; Malignancy; Monoclonal antibodies; Patients; Plasma; prolonged SARS‐CoV‐2 infection; SARS‐CoV‐2‐antibody containing plasma; Severe acute respiratory syndrome coronavirus 2; COVID‐19; prolonged SARS‐CoV‐2 infection; SARS‐CoV‐2‐antibody containing plasma
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.34988

Immunocompromised patients are at high risk to fail clearance of SARS‐CoV‐2. Prolonged COVID‐19 constitutes a health risk and a management problem as cancer treatments often have to be disrupted. As SARS‐CoV‐2 evolves, new variants of concern have emerged that evade available monoclonal antibodies. Moreover, antiviral therapy promotes SARS‐CoV‐2 escape mutations, particularly in immunocompromised patients. These patients frequently suffer from prolonged infection. No successful treatment has been established for persistent COVID‐19 infection. Here, we report on a series of 21 immunocompromised patients with COVID‐19—most of them hematologic malignancies—treated with plasma obtained from recently convalescent or vaccinated donors or a combination thereof. Repeated dosing of SARS‐CoV‐2‐antibody‐containing plasma could clear SARS‐CoV‐2 infection in 16 out of 21 immunocompromised patients even if COVID‐19‐specific treatments failed to induce sustained viral clearance or to improve clinical course of SARS‐CoV‐2 infection. Ten patients were major responders defined as an increase delta(d)Ct of > = 5 after the first administration of convalescent and/or vaccinated plasma (C/VP). On average, SARS‐CoV‐2 PCR Ct values increased from a median value of 22.55 (IQR = 19.10–24.25) to a median value of 29.57 (IQR = 27.55–34.63; p = <.0001) in the major response subgroup. Furthermore, when treated a second time with C/VP, even 4 out of 5 of the initial nonresponders showed an increase in Ct‐values from a median value of 23.13 (IQR = 17.75–28.05) to a median value of 32.79 (IQR = 31.75–33.75; p = .013). Our results suggest that C/VP could be a feasible treatment of COVID‐19 infection in patients with hematologic malignancies who did not respond to antiviral treatment. What's new? Hematologic cancer patients still have a high risk of prolonged infection and death from COVID‐19. So far, no definitive treatment has been established in this vulnerable patient group. Here, the authors report on a series of 21 immunocompromised patients with COVID‐19, most of them with hematologic malignancies, treated with plasma obtained from convalescent or vaccinated donors. The plasma retained activity against SARS‐CoV‐2 variants that had rendered monoclonal therapies ineffective, with plasma administration constituting a safe and feasible treatment. Virus clearance may allow to continue cancer therapy and decrease risk of infection to staff.