Convalescent plasma therapy for B-cell-depleted patients with protracted COVID-19

Blood. 2020 Nov 12;136(20):2290-2295. doi: 10.1182/blood.2020008423.


Anti-CD20 monoclonal antibodies are widely used for the treatment of hematological malignancies or autoimmune disease but may be responsible for a secondary humoral deficiency. In the context of COVID-19 infection, this may prevent the elicitation of a specific SARS-CoV-2 antibody response. We report a series of 17 consecutive patients with profound B-cell lymphopenia and prolonged COVID-19 symptoms, negative immunoglobulin G (IgG)-IgM SARS-CoV-2 serology, and positive RNAemia measured by digital polymerase chain reaction who were treated with 4 units of COVID-19 convalescent plasma. Within 48 hours of transfusion, all but 1 patient experienced an improvement of clinical symptoms. The inflammatory syndrome abated within a week. Only 1 patient who needed mechanical ventilation for severe COVID-19 disease died of bacterial pneumonia. SARS-CoV-2 RNAemia decreased to below the sensitivity threshold in all 9 evaluated patients. In 3 patients, virus-specific T-cell responses were analyzed using T-cell enzyme-linked immunospot assay before convalescent plasma transfusion. All showed a maintained SARS-CoV-2 T-cell response and poor cross-response to other coronaviruses. No adverse event was reported. Convalescent plasma with anti-SARS-CoV-2 antibodies appears to be a very promising approach in the context of protracted COVID-19 symptoms in patients unable to mount a specific humoral response to SARS-CoV-2.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Viral / immunology*
  • B-Lymphocytes / immunology
  • B-Lymphocytes / pathology*
  • Betacoronavirus / immunology*
  • Blood Component Transfusion
  • COVID-19
  • COVID-19 Serotherapy
  • Coronavirus Infections / blood
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / therapy
  • Coronavirus Infections / virology
  • Female
  • France
  • Hematologic Neoplasms / complications
  • Humans
  • Immune Sera / administration & dosage*
  • Immunization, Passive
  • Lymphopenia / etiology
  • Lymphopenia / pathology
  • Lymphopenia / therapy*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / therapy
  • Pneumonia, Viral / virology
  • SARS-CoV-2


  • Antibodies, Viral
  • Immune Sera