Severe COVID-19 and Blood Cancer: Plasma Therapy May Help

Nancy A. Melville

June 10, 2022

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

For patients with severe COVID-19 who had an underlying hematologic malignancy or solid cancer, outcomes were significantly better following treatment with plasma from convalescent and vaccinated patients, new research shows.

The study demonstrated that "plasma from convalescent or vaccinated individuals shortens the time to improvement in hematological and solid cancer patients with severe COVID-19" and "prolongs overall survival," said study co-author Maike Janssen, MD, of the Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.

Janssen presented the study findings on June 10 at the 2022 European Hematology Association (EHA) Annual Meeting, held in Vienna.

Although people with COVID-19 do not appear to benefit from treatment with convalescent plasma, some data indicate that certain patients who cannot mount a strong immune response to SARS-CoV-2 infection may benefit.

In this recent multicenter study, 134 patients with confirmed COVID-19 whose oxygen saturation was 94% or lower were randomly assigned to undergo treatment with convalescent or vaccinated SARS-CoV-2 plasma (n = 68) or to receive standard of care (n = 66). Patients fell into four clinical groups: those with a hematologic malignancy or who had undergone active cancer therapy for any cancer within the past 24 months; those with chronic immunosuppression; those between the ages of 50 and 75 with lymphopenia and/or elevated D-dimer levels; and those older than 75 years.

The convalescent or vaccinated SARS-CoV-2 plasma was administered in two bags (238 – 337 mL plasma each) from different donors on days 1 and 2. Only plasma from donors with high levels of neutralizing activity (titers above 1:80) were included. The primary endpoint was time to improvement by 2 points on a 7-point scale or discharge from the hospital. The secondary endpoint was improvement in overall survival.

The authors found that overall, patients in the plasma group demonstrated a shorter time to improvement — median of 12.5 days, vs 18 days — but the difference was not significant (P = .29).

However, for the subgroup of 56 patients with hematologic/solid cancers, the time to improvement was significantly shorter: 13 days, vs 31 days (hazard ratio [HR], 2.5; P = .003).

Similarly, plasma therapy did not improve overall survival in the study population overall — there were 12 deaths in the plasma group over 80 days, vs 15 in the control group (P = .80). However, patients in the hematologic/solid cancer subgroup who received plasma therapy did demonstrate significantly better overall survival (HR, 0.28; P = .042).

No similar significant differences in time to improvement or overall survival were observed in the other three groups. "We found that plasma did not improve outcomes in immune-competent patients with other risk factors and/or older age," Janssen said.

Although study enrollment ended when the Omicron variant began surging, Janssen noted that plasma from Omicron patients may also be of benefit to those with hematologic cancers.

"We have treated some patients in individual cases using plasma from Omicron patients who were already vaccinated or with breakthrough infections, and we did see benefits in those cases," she noted.

The study was funded by the Federal Ministry of Education and Research, Germany. Janssen has disclosed no relevant financial relationships.

European Hematology Association (EHA) 2022 Annual Meeting: Abstract S282. Presented June 10, 2022.

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