Efficacy of convalescent plasma therapy in immunocompromised patients with COVID-19: A case report
Genni Casarola1,2, Marco D'Abbondanza1,2, Rosa Curcio1,2
1Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Insights
High-titer COVID-19 convalescent plasma (CCP) may be effective for immunocompromised patients with prolonged SARS-CoV-2 infection. This treatment led to complete viral clearance and symptom resolution in a case study, suggesting passive antibody infusion aids immune response.
Area of Science:
- Immunology
- Virology
- Infectious Diseases
Background:
- Management of immunocompromised patients with COVID-19 remains a clinical challenge.
- High-titer COVID-19 convalescent plasma (CCP) is being investigated for its potential efficacy in this population.
- Prolonged SARS-CoV-2 shedding and severe disease are characteristic of immunocompromised individuals.
Observation:
- A 52-year-old immunocompromised female patient with B-cell lymphoma experienced prolonged SARS-CoV-2 shedding and severe COVID-19.
- Initial treatment with remdesivir did not achieve sustained clinical remission.
- The patient required re-hospitalization due to symptom recrudescence and bilateral interstitial pneumonia.
Findings:
- Administration of CCP resulted in complete resolution of clinical and radiological findings.
- Viral cultures confirmed the absence of SARS-CoV-2 cytopathic effect post-treatment.
- The case suggests that while T-cell response may be insufficient, passively infused antibodies in CCP can boost the host's response and promote viral clearance.
Implications:
- CCP infusion may be a viable therapeutic option for selected immunocompromised patients with severe COVID-19.
- Further research is warranted to investigate the mechanisms of host response in immunocompromised individuals with SARS-CoV-2.
- Clinical trials should evaluate the effectiveness of CCP in specific patient cohorts with impaired immune responses.
Background:
Management of immunocompromised COVID-19 patients is the object of current debate. Accumulating evidence suggest that treatment with high-titer COVID-19 convalescent plasma (CCP) may be effective in this characteristic clinical scenario.
Case Report:
A 52-years old immunocompromised female patient, previously treated with rituximab for low grade B-cell lymphoma, showed prolonged SARS-CoV-2 shedding and a long-term course of signs of severe COVID-19. A first cycle of treatment with remdesivir, a nucleotide analogue prodrug effective in inhibiting SARS-CoV-2 replication, did not provide fully and sustained clinical remission. A second hospitalization was deemed necessary after 10 days from the first hospital discharge due to recrudescence of symptoms of severe COVID-19 and the evidence of bilateral interstitial pneumonia at the chest-CT scan. Clinical and radiological findings completely disappeared after CCP administration. The viral culture confirmed the absence of SARS-CoV-2-related cytopathic effect. The clinical evaluation, performed two months after hospital discharge, was unremarkable.
Results:
Findings from our case report suggest that the host T-cell specific response to SARS-CoV-2 is not sufficient to reduce viral load in the absence of neutralizing antibodies. Acquired immune antibodies and/or related components passively infused with CCP might help in boosting the plasma recipient response to the virus and promoting complete viral clearance.
Conclusions:
Independently from negative results in immunocompetent individuals, the potential effectiveness of CCP infusion in selected cohorts of patients with primary or secondary impaired immune response should be tested. Further research about mechanisms of host response in immunocompromised patients with SARS-CoV-2 infection is required.
