Patientt-blood management for COVID19 convalescent plasma therapy: should donor-recipient differences in concentration and affinity of neutralizing antibodies drive use?

Focosi, Daniele; Maggi, Fabrizio; Franchini, Massimo; Aguzzi, Adriano; Lanza, Maria; Mazzoni, Alessandro; Menichetti, Francesco

BACKGROUND: COVID19 convalescent plasma (CCP) is being extensively investigated as a treatment, with mixed results to date. Overall, there has been a generalized lack of appropriateness in prescriptions, which is termed patient-blood management in the field of transfusion medicine. OBJECTIVES: We aimed at dissecting study design variables which could affect clinical outcome after CCP therapy. We focus here on variables such as pretransfusion antibody testing in recipients, dose adjustements, and antibody affinity measurements. SOURCES: We searched PubMed and preprint servers for relevant preclinical and clinical studies discussing each of these variables in the field of CCP therapy. CONTENT: We show evidences on how neglecting those variables has affected the outcomes of the vast majority of CCP clinical trials to date.. IMPLICATIONS: A better understanding of such variables will improve the design of the next generation of CCP clinical trials. This will likely lead to better clinical outcomes and minimize risks from subneutralizing neutralizing antibody doses.