Case Report: Stepwise Anti-Inflammatory and Anti-SARS-CoV-2 Effects Following Convalescent Plasma Therapy With Full
Aurelia Zimmerli1, Matteo Monti1,2, Craig Fenwick3
1Department of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Frontiers in Immunology
|May 10, 2021
Summary
Convalescent plasma rapidly reduced inflammation and cleared SARS-CoV-2 in an immunosuppressed COVID-19 patient. This suggests potential for broader use in immunocompromised individuals receiving B-cell depleting therapies.
Area of Science:
- Immunology
- Virology
- Oncology
Background:
- Concerns exist regarding SARS-CoV-2 effects on immunocompromised patients, especially those on B-cell depleting agents.
- Convalescent plasma is a potential therapy for these vulnerable patients.
- Understanding convalescent plasma mechanisms is key for optimizing its use.
Observation:
- A deeply immunosuppressed patient with chronic lymphoid leukemia, treated with rituximab and chemotherapy, developed COVID-19.
- The patient's severe T and B cell lymphopenia provided a unique model to assess convalescent plasma efficacy.
- Clinical, biological, radiological, and virological parameters were monitored throughout treatment.
Findings:
- The first convalescent plasma transfusion rapidly improved pneumonia, inflammation, and blood counts, suggesting immunomodulatory effects.
- Subsequent transfusions led to increased anti-SARS-CoV-2 neutralizing antibodies.
- This was associated with progressive viral clearance, complete viral eradication, and full clinical recovery.
Implications:
- Convalescent plasma demonstrated a stepwise therapeutic effect: initial anti-inflammatory activity followed by viral clearance.
- These findings support the expanded use of convalescent plasma in immunosuppressed COVID-19 patients.
- The results may inform future strategies using monoclonal antibodies for this patient population.
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