SARS-CoV-2 convalescent plasma therapy in pediatric patient after hematopoietic stem cell transplantation

Immunocompromised patients, including HSCT recipients, may have a poor prognosis after contracting COVID-19 due to the absence of a pathogen-specific adaptive immune response. One of the possible options for severe COVID-19 treatment may be the transfusion of hyperimmune SARS-CoV-2 convalescent plas...

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Bibliographic Details
Published in:Transfusion and apheresis science 2021-02, Vol.60 (1), p.102983-102983, Article 102983
Main Authors: Balashov, Dmitry, Trakhtman, Pavel, Livshits, Anna, Kovalenko, Irina, Tereshenko, Galina, Solopova, Galina, Petraikina, Elena, Maschan, Alexei, Novichkova, Galina
Format: Article
Language:English
Subjects:
Allografts
Antibodies, Monoclonal, Humanized - administration & dosage
Convalescent plasma
COVID-19
COVID-19 - blood
COVID-19 - etiology
COVID-19 - therapy
COVID-19 Serotherapy
Female
Hematopoietic Stem Cell Transplantation
Humans
Immunization, Passive
Immunocompromised patients
Infant
Leukemia, Myelomonocytic, Juvenile - blood
Leukemia, Myelomonocytic, Juvenile - complications
Leukemia, Myelomonocytic, Juvenile - therapy
Pediatric
Plasma
SARS-CoV-2 - metabolism
Stem cell transplantation
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Summary:Immunocompromised patients, including HSCT recipients, may have a poor prognosis after contracting COVID-19 due to the absence of a pathogen-specific adaptive immune response. One of the possible options for severe COVID-19 treatment may be the transfusion of hyperimmune SARS-CoV-2 convalescent plasma. A 9-month-old girl with juvenile myelomonocytic leukemia received an HSCT from a haploidentical donor. On day +99, during routine virologic monitoring, SARS-CoV-2 was detected without any clinical symptoms. On day +144, the child developed a polysegmental bilateral viral pneumonia with 60 % damage to the lung tissue and confirm a positive SARS-Cov-2 results in throat swab. The patient was treated with tocilizumab and three doses of fresh frozen plasma obtained from a SARS-CoV-2 convalescent patient. Therapy with tocilizumab and three doses of fresh frozen plasma was well tolerated. In spite of full resolution of the lung lesions, complete elimination of SARS-CoV-2 has not been achieved 4 months after the first detection, which is due to persistence of secondary immunodeficiency after HSCT and the lack of reconstitution of the adaptive immune response. This case represents a demonstration of an atypical course of COVID-19 and the delayed development of lung lesions, which was most likely associated with the features of the patient's immune status after HSCT. SARS-CoV-2 convalescent plasma in combination with other therapeutic approaches is one of the possible curative options for this clinical situation.
ISSN:1473-0502
1878-1683
1473-0502
DOI:10.1016/j.transci.2020.102983