How much does plasma administration help in patients with hematological neoplasms?

COVID-19 is a life-threatening infection for certain categories of patients such as those with comorbidities as well as patients with impaired immune function. Antibody production is a key component of the immune response that is essential for successful infection control. In addition, stimulating the production of antibodies through the SARS-CoV-2 vaccine is very important in preventing infection.

The use of diseased plasma, obtained from fully recovered volunteer plasma donors and containing high titers of antibodies to SARS-CoV-2, is a treatment option that has already been widely tested since the onset of the pandemic in many centers. The results of different studies differ, most likely due to different patient populations and different methodologies. However, there are several observational studies that show that this treatment has resulted in the improvement of patients’ clinical condition and in some cases the improvement of survival. In a recent publication in the international journal “Microorgansims” in April 2021, by a group of researchers of EKPA with the participation of Professors and Professors of the Medical School, Vasiliki Pappa, Evangelos Terpo, Anastasia Antoniadou, Anastasia Kotanidou, Marianna Politou, Ioannis Kalomenidis, Garyfallia Poulakou, Aristotelis Bamia, Sotirios Tsiodra and Thanos Dimopoulos (Rector of EKPA), a prospective study conducted in 5 Hospitals of Athens, announced the initial results of the plasma administration of patients, in the first 60 patients.

The study included patients with severe disease with symptoms lasting less than 10 days as well as intubated patients with a duration of less than 72 hours. This study showed that the plasma administration of patients treated with severe COVID-19 had very positive results. Specifically, in 60 patients who received plasma and standard therapy, compared with a group of 59 patients who had the same clinical characteristics and received standard plasma-free treatment, the mortality of patients who received plasma was lower (3.4% in comparison with 13.6% in the control group) during the study follow-up. Statistical analysis also showed that patients who received plasma patients had a significantly lower risk of death, significantly better survival, and significantly higher chances of being cannulated. In addition, high plasma antibody titers in patients resulted in significantly better patient survival. The study has been completed with the inclusion of 113 patients and the results are awaited with interest.

Although stimulating plasma administration has not been confirmed by large randomized trials, a retrospective analysis of 3082 patients in the United States who received plasma for severe COVID-19 early onset of symptoms showed a significant reduction in mortality for non-intubated patients. plasma containing high titers of anti-SARS-CoV-2 antibodies. Based on these results, the FDA modified the authorization for emergency plasma administration of patients containing high antibody titers to patients with severe COVID-19 infection and early in the course of the disease as well as to patients with reduced ability to produce antibodies due to immunosuppression.

Patients with haematological neoplasms present with severe immune disorders either due to the disease or due to treatment with agents that suppress the function of the immune system and lead, among other things, to the reduced production of antibodies. This deficiency of the immune system in patients with Hematologic malignancies (such as Chronic Lymphatic Leukemia, Multiple Myeloma, Acute Leukemias, Lymphomas, etc.) results in an increased incidence of COVID-19 complications and increased patient mortality. Based on this data, researchers from Vanderbilt University in Nashville, USA, conducted a retrospective multicenter study of plasma delivery in patients with hematologic neoplasms and COVID-19. Patient data were obtained from the common COVID-19 and Cancer Patient Registry. The results of the study were published in the journal JAMA Oncology on June 17, 2021 with Michael A. Thompson as the first author. The aim of the study was to estimate the day mortality of 30, 134 patients with hematopoietic neoplasms and COVID-19 who received the appropriate treatment in combined with diseased plasma. Patients were compared with a control group of 823 patients with the same clinical features, who received only the indicated treatment. Statistical analysis showed that plasma administration resulted in a significant reduction in the risk of death on day 30 by 40%, a significant reduction in mortality by 60% for the 338 patients in the Intensive Care Unit and a significant reduction in mortality by 68%, for the 227 patients who needed mechanical respiratory support.

These favorable results are expected to be confirmed through randomized studies and for this purpose a new randomized study is planned in Athens of patients with hematological neoplasms who are hospitalized with moderate or severe form of COVID-19 and who, by chance, will receive the indicated treatment in combination with sick plasma or only the indicated treatment. The study will soon begin under the auspices of the Medical School of EKPA, with main researchers Professors Vasiliki Pappa and Marianna Politou and Professor Evangelos Terpos and the participation of 5 hospitals in Athens that treat patients with hematopoietic neoplasms. This study is expected to support the indication for the administration of plasma therapy to the sick in this vulnerable group of patients with reduced antibody production capacity and therefore unsatisfactory control of COVID-19 infection.


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