Convalescent plasma therapy for B-cell–depleted patients with protracted COVID-19

Hueso, Thomas; Pouderoux, Cécile; Péré, Hélène; Beaumont, Anne-Lise; Raillon, Laure-Anne; Ader, Florence; Chatenoud, Lucienne; Eshagh, Déborah; Szwebel, Tali-Anne; Martinot, Martin; Camou, Fabrice; Crickx, Etienne; Michel, Marc; Mahevas, Matthieu; Boutboul, David; Azoulay, Elie; Joseph, Adrien; Hermine, Olivier; Rouzaud, Claire; Faguer, Stanislas; Petua, Philippe; Pommeret, Fanny; Clerc, Sébastien; Planquette, Benjamin; Merabet, Fatiha; London, Jonathan; Zeller, Valérie; Ghez, David; Veyer, David; Ouedrani, Amani; Gallian, Pierre; Pacanowski, Jérôme; Mékinian, Arsène; Garnier, Marc; Pirenne, France; Tiberghien, Pierre; Lacombe, Karine

Abstract Anti-CD20 monoclonal antibodies are widely used for the treatment of hematological malignancies or autoimmune disease but may be responsible for a secondary humoral deficiency. In the context of COVID-19 infection, this may prevent the elicitation of a specific SARS-CoV-2 antibody response. We report a series of 17 consecutive patients with profound B-cell lymphopenia and prolonged COVID-19 symptoms, negative immunoglobulin G (IgG)-IgM SARS-CoV-2 serology, and positive RNAemia measured by digital polymerase chain reaction who were treated with 4 units of COVID-19 convalescent plasma. Within 48 hours of transfusion, all but 1 patient experienced an improvement of clinical symptoms. The inflammatory syndrome abated within a week. Only 1 patient who needed mechanical ventilation for severe COVID-19 disease died of bacterial pneumonia. SARS-CoV-2 RNAemia decreased to below the sensitivity threshold in all 9 evaluated patients. In 3 patients, virus-specific T-cell responses were analyzed using T-cell enzyme-linked immunospot assay before convalescent plasma transfusion. All showed a maintained SARS-CoV-2 T-cell response and poor cross-response to other coronaviruses. No adverse event was reported. Convalescent plasma with anti–SARS-CoV-2 antibodies appears to be a very promising approach in the context of protracted COVID-19 symptoms in patients unable to mount a specific humoral response to SARS-CoV-2.