TY - JOUR
T1 - Case Series
T2 - Convalescent Plasma Therapy for Patients with COVID-19 and Primary Antibody Deficiency
AU - Lang-Meli, Julia
AU - Fuchs, Jonas
AU - Mathé, Philipp
AU - Ho, Hsi en
AU - Kern, Lisa
AU - Jaki, Lena
AU - Rusignuolo, Giuseppe
AU - Mertins, Susanne
AU - Somogyi, Vivien
AU - Neumann-Haefelin, Christoph
AU - Trinkmann, Frederik
AU - Müller, Michael
AU - Thimme, Robert
AU - Umhau, Markus
AU - Quinti, Isabella
AU - Wagner, Dirk
AU - Panning, Marcus
AU - Cunningham-Rundles, Charlotte
AU - Laubner, Katharina
AU - Warnatz, Klaus
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
KW - COVID-19
KW - Common variable immunodeficiency
KW - Convalescent plasma
KW - Hypogammaglobulinemia
KW - Inborn errors of immunity
KW - Primary immunodeficiencies
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85120996682&partnerID=8YFLogxK
U2 - 10.1007/s10875-021-01193-2
DO - 10.1007/s10875-021-01193-2
M3 - Article
C2 - 34893946
AN - SCOPUS:85120996682
SN - 0271-9142
VL - 42
SP - 253
EP - 265
JO - Journal of Clinical Immunology
JF - Journal of Clinical Immunology
IS - 2
ER -