Use of Convalescent Plasma in COVID-19 Patients With Immunosuppression

To better understand the relationship between death from COVID-19 in patients with immunosuppression and use of convalescent plasma therapy, experts from Mayo Clinic and other leading institutions reviewed 75 reports — including one large matched-control registry study, 51 case reports and 23 case series — representing 238 patients with immunosuppression who received convalescent plasma therapy for COVID-19.

The available data provide evidence suggesting fewer deaths and rapid clinical improvement in patients with several forms of immunosuppression after receiving COVID-19 convalescent plasma therapy. The usefulness of convalescent plasma or other forms of antibody therapy in treating patients with COVID-19 who have immune deficiency or immunosuppression warrants further investigation.

Key points include:

  • The review focused on studies of patients whose immune systems were suppressed due to hypogammaglobulinemia or X-linked agammaglobulinemia, common variable immunodeficiency, hematologic malignancy, or solid organ transplant; who had confirmed diagnoses of COVID-19; and who received COVID-19 convalescent plasma therapy.
  • Overall mortality among the reviewed cases was 16%, with approximately 60% of patients demonstrating rapid clinical improvement within five days of receiving convalescent plasma therapy.
  • The observed mortality rate for patients with agammaglobulinemia was 7% (one of 15 patients), and rapid improvement in supplemental oxygen was observed in three of six patients (50%) whose records reported on these metrics.
  • Among the seven patients with common variable immunodeficiency, approximately 50% were receiving mechanical ventilation or extracorporeal membrane oxygenation and one death was observed.
  • The research team identified 150 patients with hematologic malignancies who had COVID-19 and were treated with convalescent plasma. The mortality rate for this group was 20% (30 of 150 patients), with 37 patients who demonstrated rapid clinical improvement after convalescent plasma transfusion. The average time between convalescent plasma transfusion and hospital discharge was 27 days.
  • The authors identified 66 patients with COVID-19 who had received solid organ transplants and were treated with convalescent plasma. Of these, mortality was observed in nine patients (14%), four patients remained hospitalized at the end of the observation period and 25 patients demonstrated rapid improvement in clinical symptomatology.