Convalescent plasma-mediated resolution of COVID-19 in a patient with humoral immunodeficiency

Kazuhito Honjo; Ronnie M Russell; Ran Li; Weimin Liu; Regina Stoltz; Edlue M Tabengwa; Yutao Hua; Lynn Prichard; Ashton N Kornbrust; Sarah Sterrett; Marisa B Marques; Jose L Lima; Chris M Lough; Todd P McCarty; Thomas J Ketas; Theodora Hatziioannou; Paul D Bieniasz; David T Redden; John P Moore; Paul A Goepfert; Sonya L Heath; Beatrice H Hahn; Randall S Davis

doi:10.1016/j.xcrm.2020.100164

Convalescent plasma-mediated resolution of COVID-19 in a patient with humoral immunodeficiency

Cell Rep Med. 2020 Dec 5;2(1):100164. doi: 10.1016/j.xcrm.2020.100164. eCollection 2021 Jan 19.

Authors

Kazuhito Honjo¹, Ronnie M Russell^{2

3}, Ran Li¹, Weimin Liu², Regina Stoltz², Edlue M Tabengwa¹, Yutao Hua¹, Lynn Prichard¹, Ashton N Kornbrust⁴, Sarah Sterrett¹, Marisa B Marques⁴, Jose L Lima⁴, Chris M Lough⁵, Todd P McCarty¹, Thomas J Ketas⁶, Theodora Hatziioannou⁷, Paul D Bieniasz^{7

8}, David T Redden⁹, John P Moore⁶, Paul A Goepfert^{1

10}, Sonya L Heath^{1

10}, Beatrice H Hahn^{2

3}, Randall S Davis^{1

10

11

12}

Affiliations

¹ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
² Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
³ Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
⁴ Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
⁵ LifeSouth Community Blood Centers, Gainesville, FL 32607, USA.
⁶ Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10065, USA.
⁷ Laboratory of Retrovirology, The Rockefeller University, New York, NY 10028, USA.
⁸ Howard Hughes Medical Institute, The Rockefeller University, New York, NY 10028, USA.
⁹ Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
¹⁰ Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
¹¹ Department of Biochemistry & Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
¹² Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA.

Abstract

Convalescent plasma (CP) is widely used to treat COVID-19, but without formal evidence of efficacy. Here, we report the beneficial effects of CP in a severely ill COVID-19 patient with prolonged pneumonia and advanced chronic lymphocytic leukemia (CLL), who was unable to generate an antiviral antibody response of her own. On day 33 after becoming symptomatic, the patient received CP containing high-titer (ID₅₀ > 5,000) neutralizing antibodies (NAbs), defervesced, and improved clinically within 48 h and was discharged on day 37. Hence, when present in sufficient quantities, NAbs to SARS-CoV-2 have clinical benefit even if administered relatively late in the disease course. However, analysis of additional CP units revealed widely varying NAb titers, with many recipients exhibiting endogenous NAb responses far exceeding those of the administered units. To obtain the full therapeutic benefits of CP immunotherapy, it will thus be important to determine the neutralizing activity in both CP units and transfusion candidates.

Keywords: CLL; COVID-19; SARS-CoV-2; chronic lymphocytic leukemia; convalescent plasma; immunodeficiency; immunotherapy; neutralizing antibodies; pneumonia.

Publication types

Case Reports
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Antibodies, Neutralizing / administration & dosage
COVID-19 / complications
COVID-19 / pathology
COVID-19 / therapy*
COVID-19 / virology
COVID-19 Serotherapy
Female
Humans
Immunization, Passive
Immunocompromised Host
Leukemia, Lymphocytic, Chronic, B-Cell / complications
Leukemia, Lymphocytic, Chronic, B-Cell / pathology
Lung / diagnostic imaging
SARS-CoV-2 / isolation & purification
Severity of Illness Index
Tomography, X-Ray Computed

Substances

Antibodies, Neutralizing

Abstract

Publication types

MeSH terms

Substances

Grants and funding