Antonio Arrieta1,2, Alvaro E Galvis1,2, Tricia Morphew3, Louis Ehwerhemuepha4, Stephanie Osborne5, Claudia Enriquez5, Karen Imfeld6, Janet Hoang6, Delma Nieves1,2, Negar Ashouri1,2, Jasjit Singh1,2, Diane Nugent2,6. 1. From the CHOC Children's Hospital, Division of Infectious Diseases, Orange, California. 2. Department of Pediatrics, University of California, Irvine, California. 3. CHOC Children's Hospital, Orange, California; Morphew Consulting, LLC. 4. CHOC Children's Hospital, Health Care Informatics, Orange, California. 5. CHOC Children's Hospital of Orange County, Research Administration, Orange, California. 6. CHOC Children's Hospital, Division of Hematology, Orange, California.
Abstract
BACKGROUND: Therapies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its life-threatening respiratory infection coronavirus disease 2019 (COVID-19) have been evaluated, including COVID-19 convalescent plasma (CCP). Multiple large reports of CCP treatment in adults exist. Pediatric data on CCP safety and efficacy are limited. METHODS: Single-center prospective, open-label trial looking at safety, antibody kinetics and outcomes of CCP (10 mL/kg, max 1 unit) treatment for COVID-19 in hospitalized pediatric patients with moderate to severe disease or at high-risk for serious illness. RESULTS: Thirteen patients were enrolled. No infusion-related adverse events occurred. No hematologic or metabolic adverse events were noted during hospitalization or at 3-weeks. Ten patients had clinical improvement by day 7 (WHO eight-category ordinal severity scale for COVID-19). Following CCP, anti-SARS-CoV-2 anti-nucleocapsid IgG increased significantly at 24 hours and high levels were sustained at 7- and 21-days. Transient IgM response was noted. Twelve patients (92.3%) were discharged home, 9 (75%) by day 7 post-CCP. One remained on invasive ventilatory support 42 days after CCP and was eventually discharged to an intermediate care facility. The single patient death was retrospectively confirmed to have had brain death before CCP. CONCLUSION: CCP was well tolerated in pediatric patients, resulted in rapid antibody increase, and did not appear to interfere with immune responses measured at 21 days. More pediatric data are necessary to establish the efficacy of CCP, but our data suggest benefit in moderate to severe COVID-19 when used early. Other immunologic or antiviral interventions may be added as supported by emerging data.
BACKGROUND: Therapies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its life-threatening respiratory infection coronavirus disease 2019 (COVID-19) have been evaluated, including COVID-19 convalescent plasma (CCP). Multiple large reports of CCP treatment in adults exist. Pediatric data on CCP safety and efficacy are limited. METHODS: Single-center prospective, open-label trial looking at safety, antibody kinetics and outcomes of CCP (10 mL/kg, max 1 unit) treatment for COVID-19 in hospitalized pediatric patients with moderate to severe disease or at high-risk for serious illness. RESULTS: Thirteen patients were enrolled. No infusion-related adverse events occurred. No hematologic or metabolic adverse events were noted during hospitalization or at 3-weeks. Ten patients had clinical improvement by day 7 (WHO eight-category ordinal severity scale for COVID-19). Following CCP, anti-SARS-CoV-2 anti-nucleocapsid IgG increased significantly at 24 hours and high levels were sustained at 7- and 21-days. Transient IgM response was noted. Twelve patients (92.3%) were discharged home, 9 (75%) by day 7 post-CCP. One remained on invasive ventilatory support 42 days after CCP and was eventually discharged to an intermediate care facility. The single patientdeath was retrospectively confirmed to have had brain death before CCP. CONCLUSION:CCP was well tolerated in pediatric patients, resulted in rapid antibody increase, and did not appear to interfere with immune responses measured at 21 days. More pediatric data are necessary to establish the efficacy of CCP, but our data suggest benefit in moderate to severe COVID-19 when used early. Other immunologic or antiviral interventions may be added as supported by emerging data.
Authors: Oren Gordon; Mary Katherine Brosnan; Steve Yoon; Dawoon Jung; Kirsten Littlefield; Abhinaya Ganesan; Christopher A Caputo; Maggie Li; William R Morgenlander; Stephanie N Henson; Alvaro A Ordonez; Patricia De Jesus; Elizabeth W Tucker; Nadine Peart Akindele; Zexu Ma; Jo Wilson; Camilo A Ruiz-Bedoya; M Elizabeth M Younger; Evan M Bloch; Shmuel Shoham; David Sullivan; Aaron Ar Tobian; Kenneth R Cooke; Ben Larman; Jogarao Vs Gobburu; Arturo Casadevall; Andrew Pekosz; Howard M Lederman; Sabra L Klein; Sanjay K Jain Journal: JCI Insight Date: 2022-01-25