Convalescent plasma treatment in severely immunosuppressed patients hospitalized with COVID-19: an observational study of 28 cases

Figures & data

Table 1. Patient characteristics.

Baseline characteristics	n = 28
Age, median (range)	56 (16–84)
Female sex, n (%)	15 (54)
Charlson Comorbidity Index, median (range)	2 (0–5)
Weight, median, (range)	76 (42–133)
BMI, (n = 20) median, (range)	25 (21–40)
Underlying immunosuppressive conditions and treatments
Haematological malignancy n (%)	13 (46)
Chronic lymphocytic leukaemia	4
B-cell lymphoma	3
Acute promyelocyte leukaemia	1
Myeloma	1
Waldenström’s macroglobulinemia	1
Acute lymphatic leukaemia	1
Chronic neutrophilic leukaemia	1
Leukemic mantle cell lymphoma	1
-Stem cell transplantation n (%)	1
Organ transplant n (%)	5 (18)
Kidney	4
Liver	1
Primary immunodeficiency n (%)	2 (7)
Bruton’s agammaglobulinemia	1
Goods syndrome	1
Rituximab treatment* n (%), indication	14 (50)
Multiple sclerosis	5
Haematological malignancy	5
Granulomatosis with polyangiitis (GPA)	2
Rheumatoid arthritis	1
DiGeorge’s syndrome including GLILD	1

*Immunosuppressive treatment including rituximab. GLILD: granulomatous and lymphocytic interstitial lung disease.

Table 2. Details of hospitalization and treatment.

All patients	n = 28
Length of hospitalization, days, median (range)	19 (6–140)
Days from onset of symptoms to CCP, median (range)	26 (6–68)
Days from hospital admittance to CCP, median (range)	10 (2–45)
Days from CCP to discharge, median (range)	8 (2–119)
Indication of convalescent plasma*
Risk of severe COVID-19-disease	6
Severe COVID-19-disease	2
Long duration of disease	19
Severe COVID-19-disease and long duration	1
Respiratory support on first day of CCP
Mechanical ventilation	6
HFNC	8
Oxygen, nasal cannula or mask	6
No respiratory support	6
Anticoagulant treatment	27
Corticosteroids	23
Newly administered within +/−3 days of plasma	6
Remdesivir	18
Overlapping with CCP treatment	10
Doses of plasma, median (range)	3 (2–6)

*According to the medical record and in addition to severe immunosuppression.

ICU: intensive care unit; HFNC: high flow nasal cannula.

Figure 1. (a) Temperature (for patients with a temperature above 38 °C at least once within 3 days before CCP treatment), (b) CRP, (c) Ct-values of SARS CoV2 PCR from comparable respiratory tract sites. (d) Ct-values of SARS CoV2 PCR in plasma. All patients except one received CCP on 3 consecutive days.

Table 3. Outcome after CCP treatment.

Outcome	n (%)
Within 7 days of CCP:
Reduced WHO score	13 (46)
Unchanged WHO score	12 (43)
Increased WHO score	3 (11)
Death	2 (7)
Reduced CRP (n = 20)	15 (75)
Reduced temperature* (n = 18)	14 (78)
Any of reduced WHO score, CRP or temperature	19 (68)
Death within 30 days of CCP	6 (21)
Relapse	3 (11)

*Of febrile patients.

Table 4. Demographic, clinical characteristics, treatment protocols, and outcomes of all included patients.

Patient	Sex	Age	Length	Weight	CCI	Rituximab treatment	Haematological malignancy	Indication CCP	Maximum level of care	Maximal respiratory support	Anticoagulant	Corticosteroids	Corticosteroids with CCP	Remdesivir	Remdesivir with CCP	Days to CCP*	Death within 30 days	WHO-score day 0	WHO-score day 7	Change in WHO-score	Lower temp if initially febrile	Composite outcome	NtAbs mean
1	W	49	168	82	0	Yes	No	Fever, protracted infection	RW	ONCM	Enoxaparine	No	No	No	No	52	No	5	5	0	No	No change	24
2	M	52	183	112	2	Yes	Yes	Protracted infection	RW	HFNC	Enoxaparine	Yes	Yes	No	No	60	No	6	5	−1	Yes	Improvement	640
3	M	36		77	0	Yes	No	Protracted infection and protracted PCR positivity	ICU	HFNC	Enoxaparine	Yes	Yes	No	No	31	No	6	4	−2	Yes	Improvement	155
4	M	27	172	75	0	No	No	Protracted infection and protracted PCR positivity	RW	ONCM	Enoxaparine	No	No	No	No	27	No	4	2	−2	Yes	Improvement	155
5	W	27		95	0	Yes	No	Protracted infection	RW	HFNC	Enoxaparine	Yes	No	Yes	Yes	27	No	6	5	−1	–	Improvement	238
6	M	59	133	183	4	No	Yes	Immunosuppression	ICU	Mechanical ventilation	Enoxaparine	Yes	Yes	No	No	20	Yes	6	8	2	–	No change	412
7	M	64		69	2	Yes	Yes	Protracted infection	RW	ONCM	Tinzaparin	Yes	No	No	No	29	No	4	2	−2	Yes	Improvement	205
8	W	59	175	58	0	Yes	No	Protracted infection	RW	HFNC	No	Yes	No	Yes	Yes	43	No	5	4	−1	Yes	Improvement	305
9	W	46	177	99	1	Yes	No	Recent rituximab treatment, respiratory support	RW	ONCM	Enoxaparine	Yes	Yes	No	No	11	No	5	2	−3	Yes	Improvement	36
10	M	52		82	2	No	Yes	Protracted infection	RW	HFNC	Enoxaparine	Yes	Yes	Yes	Yes	21	No	6	5	−1	Yes	Improvement	503
11	W	55		55	3	Yes	Yes	Immunosuppression	RW	No respiratory support	Enoxaparine	No	No	Yes	Yes	6	No	4	2	−2	Yes	Improvement	36
12	M	71	176	57	3	No	Yes	Protracted infection	ICU	Mechanical ventilation	Enoxaparine	Yes	No	No	No	25	Yes	8	8	0	No	Improvement	253
13	M	68	163	57	1	No	Yes	Immunosuppression	RW	HFNC	Enoxaparine	Yes	Yes	Yes	No	6	Yes	6	10	4	–	Worsening	183
14	W	47	168	106	0	Yes	No	increasing respiratory support	ICU	Mechanical ventilation	Enoxaparine	Yes	Yes	Yes	Yes	15	No	8	8	0	No	No change	138
15	W	52		56	1	Yes	No	Protracted infection	RW	ONCM	Enoxaparine	No	No	Yes	Yes	25	No	5	2	−3	Yes	Improvement	201
16	W	16		42	2	No	Yes	Mechanical ventilation	ICU	Mechanical ventilation	Dalteparin	Yes	Yes	Yes	No	23	No	8	6	−2	No	Improvement	297
17	W	78	168	69	2	Yes	Yes	recent rituximab treatment, protracted infection	RW	HFNC	Enoxaparine	Yes	Yes	Yes	Yes	13	No	5	5	0	–	Improvement	336
18	M	68	167	63	5	No	No	Protracted infection and protracted PCR positivity	ICU	Mechanical ventilation	Enoxaparine	Yes	Yes	Yes	No	13	Yes	8	10	2	–	Worsening	427
19	W	84	165	68	3	No	No	Protracted infection and protracted PCR positivity	RW	No respiratory support	Enoxaparine	Yes	No	Yes	No	40	No	4	4	0	Yes	Improvement	217
20	M	77	178	65	2	No	Yes	Protracted infection and protracted PCR positivity	ILC	HFNC	Enoxaparine	Yes	Yes	Yes	Yes	21	No	6	6	0	–	Improvement	290
21	W	60	165	85	5	No	No	Protracted infection and protracted PCR positivity	RW	ONCM	Enoxaparine	Yes	Yes	Yes	No	68	No	4	4	0	–	No change	229
22	M	74	175	79	2	No	Yes	Protracted infection and protracted PCR positivity	RW	HFNC	Enoxaparine	Yes	Yes	Yes	Yes	30	No	6	6	0	–	No change	351
23	M	57	170	60	3	Yes	Yes	Protracted infection	RW	HFNC	Enoxaparine	Yes	Yes	Yes	No	40	Yes	4	4	0	–	No change	139
24	W	68	165	87	3	No	No	Protracted infection and protracted PCR positivity	RW	HFNC	Warfarin	Yes	Yes	Yes	No	39	No	5	5	0	–	No change	272
25	M	47		84	1	Yes	No	Mechanical ventilation	ICU	Mechanical ventilation	Enoxaparine	Yes	Yes	Yes	Yes	9	No	7	4	−3	Yes	Improvement	110
26	W	44	170	63	0	Yes	No	Immunosuppression	RW	No respiratory support	Enoxaparine	No	No	No	No	34	No	4	4	0	Yes	Improvement	94
27	M	46	175	91	2	No	No	Immunosuppression, protracted PCR positivity	RW	ONCM	Enoxaparine	Yes	Yes	No	No	20	No	4	2	−2	Yes	Improvement	517
28	M	61	180	78	2	No	Yes	Immunosuppression, pcr positive in blood	ICU	Mechanical ventilation	Enoxaparine	Yes	Yes	Yes	No	8	Yes	8	8	0	Yes	Improvement	95

*From initial symptoms. Composite outcome = decrease in WHO score, temperature or CRP after CCP. ICU: intensive care unit; ILC: intermediate level care; RW: regular ward; HFNC: high flow nasal cannula; ONCM: Oxygen nasal cannula or mask; CCI: Charlson comorbidity index; W: woman; M: man.