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

Abstract

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.

Fig. 1. Flowchart.

*Excluding B-acute lymphoblastic leukemia (n = 2).

Fig. 2. Kinetics of clinical and inflammatory parameters.

All parameters were assessed on the day of convalescent plasma transfusion (day 0) and 7 days after (day +7). A cycle threshold value over 40 was considered negative. A Wilcoxon-paired test was assessed. The median and interquartile ranges are represented.

Fig. 3. Overall survival after COVID-19 convalescent plasma transfusion.

Kaplan-Meier method was used according to  the type of hematological malignancy (A); the exposition to anti-CD20 or anti-CD19 monoclonal antibodies (mAbs) (B); and the COVID-19 severity (WHO scale) (C).

Fig. 4. Forest plot representing hazard ratio (HR) of death obtained in multivariable analysis.

mAbs monoclonal antibodies.

Fig. 5. Main et sensitivity analyses of mortality risk associated with COVID-19.

Change (dot) and its 95% confidence interval (line) in mortality risk associated with COVID-19 convalescent plasma (CCP) therapy from inverse-probability weighting (IPTW) model.