tetano
Editor, Senior Moderator
Transpl Infect Dis
. 2023 Mar 16;e14055.
doi: 10.1111/tid.14055. Online ahead of print.
High-titer post-vaccine COVID-19 convalescent plasma for immunocompromised patients during the first omicron surge
Ralph Tayyar[SUP] 1 [/SUP], Lisa Kanata Wong[SUP] 2 3 [/SUP], Alex Dahlen[SUP] 4 [/SUP], Elaine Shu[SUP] 3 [/SUP], Suchitra Pandey[SUP] 2 3 [/SUP], Anne Y Liu[SUP] 1 5 [/SUP]
Affiliations
Abstract
Background: Transplant and hematologic malignancy patients have high Coronavirus disease 2019 (COVID-19) mortality and impaired vaccination responses. Omicron variant evades several monoclonal antibodies previously used in immunocompromised patients. Polyclonal COVID-19 convalescent plasma (CCP) may provide broader neutralizing capacity against new variants at high titers. Vaccination increases severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) titer in convalescent donors.
Methods: We conducted a retrospective chart review of hospitalized immunocompromised patients with COVID-19 who received high-titer CCP during the first omicron surge, collected from vaccinated donors within 6 months of pre-omicron COVID-19. Data on safety and outcomes were extracted.
Results: A total of 44 immunocompromised patients were included, 59.1% with solid organ transplant, 22.7% with hematopoietic cell transplant, 11.4% with hematologic malignancy, and 6.8% with autoimmune disease. Overall, 95% of CCP units transfused were from recently recovered and vaccinated donors and had SARS-CoV-2 antibody results 8- to 37-fold higher than the Food and Drug Administration's cutoff for high-titer CCP. There were two mild transfusion reactions. A total of 30-day mortality was 4.5%. There were no differences in 100-day mortality by underlying diagnosis, levels of immunosuppression, and timing of CCP administration. Patients with higher immunosuppression had significantly higher mean World Health Organization clinical progression scores at 30-day post-CCP compared to those with lower immunosuppression.
Conclusions: CCP is a safe, globally available treatment for immunocompromised patients with COVID-19. Mortality was lower in our cohort than that of COVID-19 patients with similar immunocompromising conditions. Post-vaccine CCP with very high titers should be prioritized for study in immunocompromised patients. Post-vaccine CCP has the potential to keep pace with new variants by overcoming mutations at sufficiently high titer.
Keywords: COVID-19 convalescent plasma; SARS-CoV-2; hematopoietic cell transplant; immunocompromised patients; solid organ transplant.
. 2023 Mar 16;e14055.
doi: 10.1111/tid.14055. Online ahead of print.
High-titer post-vaccine COVID-19 convalescent plasma for immunocompromised patients during the first omicron surge
Ralph Tayyar[SUP] 1 [/SUP], Lisa Kanata Wong[SUP] 2 3 [/SUP], Alex Dahlen[SUP] 4 [/SUP], Elaine Shu[SUP] 3 [/SUP], Suchitra Pandey[SUP] 2 3 [/SUP], Anne Y Liu[SUP] 1 5 [/SUP]
Affiliations
- PMID: 36929619
- DOI: 10.1111/tid.14055
Abstract
Background: Transplant and hematologic malignancy patients have high Coronavirus disease 2019 (COVID-19) mortality and impaired vaccination responses. Omicron variant evades several monoclonal antibodies previously used in immunocompromised patients. Polyclonal COVID-19 convalescent plasma (CCP) may provide broader neutralizing capacity against new variants at high titers. Vaccination increases severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) titer in convalescent donors.
Methods: We conducted a retrospective chart review of hospitalized immunocompromised patients with COVID-19 who received high-titer CCP during the first omicron surge, collected from vaccinated donors within 6 months of pre-omicron COVID-19. Data on safety and outcomes were extracted.
Results: A total of 44 immunocompromised patients were included, 59.1% with solid organ transplant, 22.7% with hematopoietic cell transplant, 11.4% with hematologic malignancy, and 6.8% with autoimmune disease. Overall, 95% of CCP units transfused were from recently recovered and vaccinated donors and had SARS-CoV-2 antibody results 8- to 37-fold higher than the Food and Drug Administration's cutoff for high-titer CCP. There were two mild transfusion reactions. A total of 30-day mortality was 4.5%. There were no differences in 100-day mortality by underlying diagnosis, levels of immunosuppression, and timing of CCP administration. Patients with higher immunosuppression had significantly higher mean World Health Organization clinical progression scores at 30-day post-CCP compared to those with lower immunosuppression.
Conclusions: CCP is a safe, globally available treatment for immunocompromised patients with COVID-19. Mortality was lower in our cohort than that of COVID-19 patients with similar immunocompromising conditions. Post-vaccine CCP with very high titers should be prioritized for study in immunocompromised patients. Post-vaccine CCP has the potential to keep pace with new variants by overcoming mutations at sufficiently high titer.
Keywords: COVID-19 convalescent plasma; SARS-CoV-2; hematopoietic cell transplant; immunocompromised patients; solid organ transplant.