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Hyperimmune plasma infusion in an immunocompromised Covid-19 patient previously treated for follicular lymphoma
Guido Levi1, Chiara Rocchetti2, Roberto Magri3
1Interventional Pulmonology Department, ASST Spedali Civili, Brescia. guido.levi@yahoo.it.
Insights
Hyperimmune plasma may improve outcomes for immunocompromised patients with prolonged COVID-19. This case study shows recovery after two plasma doses when standard treatments failed.
Area of Science:
- Immunology
- Infectious Diseases
- Oncology
Background:
- COVID-19 in immunocompromised patients often has a prolonged course and poor prognosis.
- Limited data exist on hyperimmune plasma efficacy in immunocompromised individuals.
- Follicular lymphoma patients undergoing chemotherapy are a vulnerable group.
Observation:
- A 62-year-old woman with follicular lymphoma had a prolonged COVID-19 infection despite standard care, including remdesivir.
- Initial hyperimmune plasma infusion was followed by worsening symptoms, including fever and increased inflammatory markers.
- A second dose of hyperimmune plasma was administered three days later.
Findings:
- Following the second plasma dose, the patient experienced rapid improvement, with fever and cough resolving within 12 hours.
- Oxygen support was discontinued, and the patient was discharged five days after the second infusion.
- Nasopharyngeal swabs tested negative for SARS-CoV-2 sixteen days post-discharge.
Implications:
- Hyperimmune plasma may be a viable treatment option for immunocompromised patients with severe, prolonged COVID-19.
- Further research is warranted to establish optimal dosing and timing of hyperimmune plasma in this population.
- This case highlights the potential benefit of exploring alternative therapies for refractory COVID-19 in immunocompromised hosts.
Abstract:
Covid-19 in immunocompromised patients shows a prolonged course and may lead to a poor prognosis. Although data on hyperimmune plasma for treatment of Covid-19 suggest an improved outcome in immunocompetent patients, limited data are currently available in immunocompromised patients. We present the case of a 62-year-old Caucasian woman, who was previously treated with obinutuzumab and bendamustine for follicular lymphoma and showed a prolonged positive test for Covid-19. Since no improvement was observed with standard of care (including remdesivir), the possibility of hyperimmune plasma infusion was discussed. A first dose of hyperimmune plasma was administered, with subsequent onset of fever, increasing inflammatory indexes and worsening radiological findings. Three days later a second dose of plasma was administered. Within twelve hours cough and fever disappeared, and oxygen at rest was discontinued. The patient was discharged 5 days later, and nasopharyngeal swabs resulted negative 16 days after discharge.
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