Discussion
We report herein an observational cohort of immunosuppressed patients,
mostly with HM (almost all with B lymphoid disease), infected by the
Omicron subvariants BA.1 or BA.2, and treated with CCP. The 28-days OS
for the whole cohort was 76% (CI = 65-84) without differences according
to the type of immunosuppression whereas the severity of COVID-19 at the
time of CCP infusion greatly impacts the outcome. Indeed patients with
high flow oxygen had a poor outcome despite CCP infusion with 53 %
28-days OS.
Early in the pandemic, our team reported the interest of CCP in
B-depleted patients such as patients with CLL or treated with
rituximab11. Despite the efficacy of CCP in such
patients our results are quite disappointing. Indeed, in the recent
observational study from the EPICOVIDEHA registry, mortality rate among
hospitalized HM patients infected with Omicron was 16.5% that reaches
23% 30-day mortality in patients with chronic lymphoid leukemia
(CLL)10. Is to note that in our cohort, 32 % of
patients needed high flow oxygen at the time of CCP infusion that could
explain the mitigate response after CCP infusion. The beneficial effect
of CCP was also described in patients with primary antibody deficiency
with a clinical improvement and a decreasing of the viral
load12. Concerning SOTR, few data are available with
two relevant series of 10 and 13 patients reporting the feasibility of
CCP with a mortality rate of 10 and 23% respectively linked to
COVID-1913,14.
To date, the time of CCP infusion remains debated. While B-depleted
patients with high oxygen need and treated with CCP had a poor
outcome7, it could be interesting in similar patients
with prolonged COVID-1911. Indeed, clinicians must
distinguish patients with protracted disease as “smoldering COVID”
from patients presenting with aggressive course. Besides the time
between CCP infusion and the symptoms onset, the disease course should
be informative and must be take into account in the decision to use CCP.
In a context of urgent need for therapeutic options when new SARS-CoV-2
variants emerge and escape current monoclonal antibodies, CCP remains an
interesting treatment option for immunosuppressed patients whatever the
underlying disease. Furthermore, some effort must be made to better
anticipate disease course that should guide the timing of CCP infusion.