Peripheral Plasma Cells Associated with Mortality Benefit in Severe COVID-19: A Marker of Disease Resolution

Boulanger, Mary; Molina, Emily; Wang, Kunbo; Kickler, Thomas; Xu, Yanxun; Garibaldi, Brian T.

BACKGROUND: Cytokines seen in severe COVID-19 are associated with proliferation, differentiation, and survival of plasma cells. Plasma cells are not routinely found in peripheral blood, though may produce virus-neutralizing antibodies in COVID-19 later in the course of an infection. METHODS: Using the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry, we identified hospitalized adult patients with confirmed SARS-CoV-2 infection and stratified by presence of plasma cells and WHO disease severity. To identify plasma cells, we employed a sensitive flow cytometric screening method for highly fluorescent lymphocytes and confirmed these microscopically. Cox regression models were used to evaluate time to death and time to clinical improvement by the presence of plasma cells in patients with severe disease. RESULTS: Of 2,301 hospitalized patients with confirmed infection, 371 had plasma cells identified. Patients with plasma cells were more likely to have severe disease, though 86.6% developed plasma cells after onset of severe disease. In patients with severe disease, after adjusting for age, sex, BMI, race and other covariates associated with disease severity, patients with plasma cells had a reduced hazard of death (aHR: 0.57; 95%CI: 0.38 to 0.87; p-value: 0.008). There was no significant association with the presence of plasma cells and time to clinical improvement. CONCLUSIONS: Patients with severe disease who have detectable plasma cells in the peripheral blood have improved mortality despite adjusting for known covariates associated with disease severity in COVID-19. Further investigation is warranted to understand the role of plasma cells in the immune response to COVID-19.