1
|
Lang-Meli J, Fuchs J, Mathé P, Ho HE, Kern L, Jaki L, Rusignuolo G, Mertins S, Somogyi V, Neumann-Haefelin C, Trinkmann F, Müller M, Thimme R, Umhau M, Quinti I, Wagner D, Panning M, Cunningham-Rundles C, Laubner K, Warnatz K. Case Series: Convalescent Plasma Therapy for Patients with COVID-19 and Primary Antibody Deficiency. J Clin Immunol 2021; 42:253-265. [PMID: 34893946 PMCID: PMC8664001 DOI: 10.1007/s10875-021-01193-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/05/2021] [Indexed: 12/23/2022]
Abstract
Patients with primary antibody deficiency are at risk for severe and in many cases for prolonged COVID-19. Convalescent plasma treatment of immunocompromised individuals could be an option especially in countries with limited access to monoclonal antibody therapies. While studies in immunocompetent COVID19 patients have demonstrated only a limited benefit, evidence for the safety, timing, and effectiveness of this treatment in antibody-deficient patients is lacking. Here, we describe 16 cases with primary antibody deficiency treated with convalescent plasma in four medical centers. In our cohort, treatment was associated with a reduction in viral load and improvement of clinical symptoms, even when applied over a week after onset of infection. There were no relevant side effects besides a short-term fever reaction in one patient. Longitudinal full-genome sequencing revealed the emergence of mutations in the viral genome, potentially conferring an antibody escape in one patient with persistent viral RNA shedding upon plasma treatment. However, he resolved the infection after a second course of plasma treatment. Thus, our data suggest a therapeutic benefit of convalescent plasma treatment in patients with primary antibody deficiency even months after infection. While it appears to be safe, PCR follow-up for SARS-CoV-2 is advisable and early re-treatment might be considered in patients with persistent viral shedding.
Collapse
Affiliation(s)
- Julia Lang-Meli
- Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Jonas Fuchs
- Institute of Virology, University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Philipp Mathé
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Hsi-En Ho
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa Kern
- Institute of Virology, University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Lena Jaki
- Institute of Virology, University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Giuseppe Rusignuolo
- Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Susanne Mertins
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Vivien Somogyi
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Enter Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Enter Heidelberg, German Center for Lung Research, Heidelberg, Germany
- Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health (CPD-BW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Müller
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Enter Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Markus Umhau
- Institute for Transfusion Medicine and Gene Therapy, University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Dirk Wagner
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Charlotte Cunningham-Rundles
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katharina Laubner
- Department of Medicine II, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Breisacher Str. 115, 79106, Freiburg, Germany.
- Center for Chronic Immunodeficiency, Medical Center - University of Freiburg and Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany.
| |
Collapse
|