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Convalescent plasma therapy for B-cell–depleted patients with protracted COVID-19

Thomas Hueso, Cecile Pouderoux, Helene Pere, Anne-Lise Beaumont, Laure-Anne Raillon, Florence Ader, Lucienne Chatenoud,
Deborah Eshagh, Tali-Anne Szwebel, Martin Martinot, Fabrice Camou, Etienne Crickx, Marc Michel, Matthieu Mahevas, David Boutboul, Elie Azoulay,16 Adrien Joseph,16 Olivier Hermine, Claire Rouzaud, Stanislas Faguer, Philippe Petua
Fanny Pommeret,22 Sebastien Clerc, ´ 23 Benjamin Planquette,23 Fatiha Merabet,24 Jonathan London,25 Valerie Zeller, ´ 25 David Ghez,1
David Veyer,6,26 Amani Ouedrani,8,9 Pierre Gallian,27,28 Jer´ ome Pacanowski, ˆ 6 Arsene M ` ekinian, ´ 29 Marc Garnier,30 France Pirenne,28,31
Pierre Tiberghien,28,32 and Karine Lacombe6,33
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Anti-CD20 monoclonal antibodies are widely used for the treatment of hematological malignancies or autoimmune disease but may be responsible for a secondary humoral deficiency. In the context of COVID-19 infection, this may prevent the elicitation of a specific SARS-CoV-2 antibody response. We report a series of 17 consecutive patients with profound B-cell lymphopenia and prolonged COVID-19 symptoms, negative immunoglobulin G (IgG)-IgM SARS-CoV-2 serology, and positive RNAemia measured by digital polymerase chain reaction who were treated with 4 units of COVID-19 convalescent plasma. Within 48 hours of transfusion, all but 1 patient experienced an improvement of clinical symptoms. The inflammatory syndrome abated within a week. Only 1 patient who needed mechanical ventilation for severe COVID-19 disease died of bacterial pneumonia. SARS-CoV2 RNAemia decreased to below the sensitivity threshold in all 9 evaluated patients. In 3 patients, virus-specific T-cell responses were analyzed using T-cell enzyme-linked immunospot assay before convalescent plasma transfusion. All showed a maintained SARS-CoV2 T-cell response and poor cross-response to other coronaviruses. No adverse event was reported. Convalescent plasma with anti–SARS-CoV-2 antibodies appears to be a very promising approach in the context of protracted COVID-19 symptoms in patients unable to mount a specific humoral response to SARS-CoV-2. (Blood. 2020;136(20):2290-2295)

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Publicado en el sitio 2020-11-23 11:25:51

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