Maria Grazia Cusi1, Edoardo Conticini2, Claudia Gandolfo3, Gabriele Anichini3, Gianni Gori Savellini3, Serafina Valente4,5, Federico Franchi5,6, Sabino Scolletta5,6, Elena Percivalle7, Bruno Frediani8,5. 1. Virology Unit, Department of Medical Biotechnologies, University of Siena, Siena, Italy. mariagrazia.cusi@unisi.it. 2. Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, viale Mario Bracci, 16, Siena, Italy. conticini.edoardo@gmail.com. 3. Virology Unit, Department of Medical Biotechnologies, University of Siena, Siena, Italy. 4. Clinical and Surgical Cardiology Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena, Siena, Italy. 5. COVID Unit, University Hospital of Siena, Siena, Italy. 6. Anesthesia and Intensive Care Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Tuscany, Italy. 7. Microbiology /Virology Unit, Department of Diagnostic Medicine, Fondazione IRCCS San Matteo, Pavia, Italy. 8. Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, viale Mario Bracci, 16, Siena, Italy.
Abstract
BACKGROUND: Convalescent plasma (CP) and hyperimmune plasma (HP) are passive immunotherapies consisting in the infusion of plasma from recovered people into infected patients. Following pre-existing evidence in many other viral diseases, such as SARS, MERS and Ebola, CP and HP have also been proposed for the treatment of COVID-19. Nevertheless, due to the lack of large, well-designed, clinical trials, no clear-cut guidelines exist about what subtype of patient CP and HP should be administered to. CASE PRESENTATION: We have reported the cases of 3 patients, all immunosuppressed and affected by non-severe, prolonged COVID-19. They were treated with HP, whose neutralizing titer was higher than 1/80. The first patient was a 55-year-old male, who had undergone lung transplant. He was under therapy with Tacrolimus and developed non-neutralizing antibodies against SARS-CoV2. The second patient was a 77-year-old female, affected by follicular lymphoma. She had tested positive for SARS-CoV2 after 6 months. The third was a 60-year-old patient, affected by chronic leukemia. He did not develop antibodies after 2-month disease. All 3 patients received HP and had tested negative for SARS-CoV2 within 2 weeks. CONCLUSION: Despite encouraging initial data, no strong evidence exist in support of CP and HP to treat COVID-19. In our experience, although limited due to the reduced number of patients, we found a good safety and efficacy of HP in 3 immuno-deficient subjects. Further data are needed in order to assess whether this subtype of patients may particularly benefit from passive immunization.
BACKGROUND: Convalescent plasma (CP) and hyperimmune plasma (HP) are passive immunotherapies consisting in the infusion of plasma from recovered people into infectedpatients. Following pre-existing evidence in many other viral diseases, such as SARS, MERS and Ebola, CP and HP have also been proposed for the treatment of COVID-19. Nevertheless, due to the lack of large, well-designed, clinical trials, no clear-cut guidelines exist about what subtype of patientCP and HP should be administered to. CASE PRESENTATION: We have reported the cases of 3 patients, all immunosuppressed and affected by non-severe, prolonged COVID-19. They were treated with HP, whose neutralizing titer was higher than 1/80. The first patient was a 55-year-old male, who had undergone lung transplant. He was under therapy with Tacrolimus and developed non-neutralizing antibodies against SARS-CoV2. The second patient was a 77-year-old female, affected by follicular lymphoma. She had tested positive for SARS-CoV2 after 6 months. The third was a 60-year-old patient, affected by chronic leukemia. He did not develop antibodies after 2-month disease. All 3 patients received HP and had tested negative for SARS-CoV2 within 2 weeks. CONCLUSION: Despite encouraging initial data, no strong evidence exist in support of CP and HP to treat COVID-19. In our experience, although limited due to the reduced number of patients, we found a good safety and efficacy of HP in 3 immuno-deficient subjects. Further data are needed in order to assess whether this subtype of patients may particularly benefit from passive immunization.
Authors: Stephen A Klassen; Jonathon W Senefeld; Patrick W Johnson; Rickey E Carter; Chad C Wiggins; Shmuel Shoham; Brenda J Grossman; Jeffrey P Henderson; James Musser; Eric Salazar; William R Hartman; Nicole M Bouvier; Sean T H Liu; Liise-Anne Pirofski; Sarah E Baker; Noud van Helmond; R Scott Wright; DeLisa Fairweather; Katelyn A Bruno; Zhen Wang; Nigel S Paneth; Arturo Casadevall; Michael J Joyner Journal: Mayo Clin Proc Date: 2021-02-17 Impact factor: 7.616