Convalescent plasma improves overall survival in patients with B-cell lymphoid malignancy and COVID-19: a longitudinal cohort and propensity score analysis

• Published in: Leukemia Vol. 36; no. 4; pp. 1025 - 1034
• Main Authors: Hueso, Thomas, Godron, Anne-Sophie, Lanoy, Emilie, Pacanowski, Jérôme, Levi, Laura I., Gras, Emmanuelle, Surgers, Laure, Guemriche, Amina, Meynard, Jean-Luc, Pirenne, France, Idri, Salim, Tiberghien, Pierre, Morel, Pascal, Besson, Caroline, Duléry, Rémy, Lamure, Sylvain, Hermine, Olivier, Gagneux-Brunon, Amandine, Freymond, Nathalie, Grabar, Sophie, Lacombe, Karine
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2022; Nature Publishing Group; Springer Nature
• Subjects: 692/308/575; 692/700/565/251; Antibodies, Viral; Blood pressure; Cancer; Cancer Research; CD20 antigen; Coronaviruses; COVID-19; COVID-19 - therapy; Critical Care Medicine; Hematology; Humans; Hypertension; Immune clearance; Immune response; Immune response (humoral); Immune system; Immunization, Passive; Immunosuppression; Immunotherapy; Intensive; Internal Medicine; Life Sciences; Lymphocytes B; Malignancy; Medical treatment; Medicine; Medicine & Public Health; Monoclonal antibodies; Mortality; Neoplasms; Oncology; Patients; Propensity Score; SARS-CoV-2; Sensitivity analysis; Severe acute respiratory syndrome coronavirus 2; Subgroups; Survival; Tumors; Viral diseases
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/s41375-022-01511-6

Patients with hematological malignancy and COVID-19 display a high mortality rate. In such patients, immunosuppression due to underlying disease and previous specific treatments impair humoral response, limiting viral clearance. Thus, COVID-19 convalescent plasma (CCP) therapy appears as a promising approach through the transfer of neutralizing antibodies specific to SARS-CoV-2. We report the effect of CCP in a cohort of 112 patients with hematological malignancy and COVID-19 and a propensity score analysis on subgroups of patients with B-cell lymphoid disease treated ( n  = 81) or not ( n  = 120) with CCP between May 1, 2020 and April 1, 2021. The overall survival of the whole cohort was 65% (95% CI = 56–74.9) and 77.5% (95% CI = 68.5–87.7) for patients with B-cell neoplasm. Prior anti-CD20 monoclonal antibody therapy was associated with better overall survival, whereas age, high blood pressure, and COVID-19 severity were associated with a poor outcome. After an inverse probability of treatment weighting approach, we observed in anti-CD20–exposed patients with B-cell lymphoid disease a decreased mortality of 63% (95% CI = 31–80) in the CCP-treated group compared to the CCP-untreated subgroup, confirmed in the other sensitivity analyses. Convalescent plasma may be beneficial in COVID-19 patients with B-cell neoplasm who are unable to mount a humoral immune response.