A team of French scientists recently demonstrated the effectiveness of convalescent plasma therapy for coronavirus disease 2019 (COVID-19) in improving the survival rate in patients with B-cell lymphoid malignancy and COVID-19. The study is currently available on the medRxiv* preprint server.
Study: Convalescent plasma improves overall survival in patients with B-cell lymphoid malignancies and COVID-19: a longitudinal cohort and propensity score analysis. Image Credit: Cryptographer / Shutterstock
Immunocompromised patients, including those with hematologic malignancies, have a significantly higher risk of death from COVID-19, a novel disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Suppressed functionality of the immune system due to the disease and associated treatment results in delayed viral clearance and a higher risk of severe COVID-19. The risk is especially higher in patients with B-cell lymphoid tumors.
In France, COVID-19 convalescent plasma therapy has been approved to treat hospitalized patients with COVID-19 immunosuppression, including patients with hematologic malignancies. Although the therapeutic benefits of plasma therapy have not been fully established in most clinical trials, there is some evidence to suggest that COVID-19 patients with B cell depletion could benefit from such therapy.
In the present study, scientists explored whether COVID-19 convalescent plasma therapy can reduce the death rate in COVID-19 patients with hematologic malignancies, particularly B-cell lymphoid malignancies.
The study included a total of 112 patients with hematologic malignancies with COVID-19 who were treated with convalescent plasma therapy. Of these, 83 had B-cell lymphoid malignancies, 10 had myeloid malignancies, and 19 had multiple myeloma. About 72% of patients had received treatment with anti-CD20 monoclonal antibodies an average of 42 days before the onset of symptoms of COVID-19.
A separate series of analyzes was performed on patients with B cell lymphoid malignancy treated (n = 81) or not (n = 120) with plasma therapy.
The overall survival rate and risk factors for COVID-19 mortality were assessed among study participants. The survival rates of patients with B-cell lymphoid malignancy treated with plasma were compared to those without treatment. In addition, the safety profile and the kinetics of inflammatory parameters during plasma therapy were investigated.
Adverse events associated with COVID-19 convalescent plasma therapy transfusion have been observed in a small fraction of patients. Specifically, a minor allergy was observed in two patients and a severe allergy was observed in one patient. In addition, a transient increase in oxygen requirements was observed in two patients.
Regarding therapeutic benefits, a significant reduction in body temperature, C reactive protein, ferritin, fibrinogen, and viral load has been observed in patients after plasma therapy. The highest survival rate of 77% was observed in patients with B-cell lymphoid malignancy treated with plasma. Considering all patients, the overall survival rate was 65% after treatment. All of the deaths reported during the study period were associated with COVID-19.
A significant association was observed between overall survival and age (above 70 years), type of malignant tumors, high blood pressure, previous exposure to anti-CD20 monoclonal antibody therapy, severity of COVID-19 and timing of plasma therapy administration. Specifically, advanced age, high blood pressure and the severity of COVID-19 have been identified as potent risk factors for death from the disease. In contrast, a strong correlation was observed between prior exposure to anti-CD20 treatment and an improvement in overall survival.
In patients with B-cell lymphoid malignancy with a history of anti-CD20 therapy, administration of plasma therapy resulted in a 63% reduction in the risk of COVID-19-related mortality.
Importance of the study
The study highlights the benefits of COVID-19 convalescent plasma therapy in reducing mortality in patients with hematologic malignancies and COVID-19. The greatest benefit was seen in patients with B cell lymphoid malignancy, especially those previously treated with anti-CD20 monoclonal therapy.
As scientists have mentioned, administering anti-spike monoclonal antibody therapy to patients with hematologic malignancies may act as a positive selection pressure for the development of escape mutations. Thus, in these patients, convalescent COVID-19 plasma therapy could be an alternative and effective intervention for a better prognosis of the disease.
medRxiv publishes preliminary scientific reports which are not peer reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.