Deployment of convalescent plasma for the prevention and treatment of COVID-19

Authors: Bloch, EM., Shoham, S., Casadevall, A., Sachais, BS., Shaz, B., Winters, JL., van, Buskirk C., Grossman, BJ., Joyner, M., Henderson, JP., Pekosz, A., Lau, B., Wesolowski, A., Katz, L., Shan, H., Auwaerter, PG., Thomas, D., Sullivan, DJ., Paneth, N., Gehrie, E., Spitalnik, S., Hod, E., Pollack, L., Nicholson, WT., Pirofski, LA., Bailey, JA., and Tobian, AA.

Publication: The Journal of Clinical Investigation; April 2020

Affiliations: Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America; Hematology, New York Blood Center Enterprises, New York, USA

Abstract: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease (COVID-19), has spurred a global health crisis. To date, there are no proven options for prophylaxis for those who have been exposed to SARS-CoV-2, nor therapy for those who develop COVID-19. Immune (i.e. “convalescent”) plasma refers to plasma that is collected from individuals, following resolution of infection and development of antibodies. Passive antibody administration through transfusion of convalescent plasma may offer the only short-term strategy to confer immediate immunity to susceptible individuals. There are numerous examples, where convalescent plasma has been used successfully as post-exposure prophylaxis and/or treatment of infectious diseases, including other outbreaks of coronaviruses (e.g., SARS-1, Middle East Respiratory Syndrome [MERS]). Convalescent plasma has also been used in the COVID-19 pandemic; limited data from China suggest clinical benefit, including radiological resolution, reduction in viral loads and improved survival. Globally, blood centers have robust infrastructure to undertake collections and construct inventories of convalescent plasma to meet the growing demand. Nonetheless, there are nuanced challenges, both regulatory and logistical, spanning donor eligibility, donor recruitment, collections and transfusion itself. Data from rigorously controlled clinical trials of convalescent plasma are also few, underscoring the need to evaluate its use objectively for a range of indications (e.g., prevention vs treatment) and patient populations (e.g., age, comorbid disease). We provide an overview of convalescent plasma, from evidence of benefit, regulatory considerations, logistical work flow and proposed clinical trials, as scale up is brought underway to mobilize this critical resource.