Standard COVID-19 therapies and vaccines have limited effectiveness in patients with impaired humoral immune responses, and these patients have a high risk of severe COVID-19. High titer COVID-19 convalescent plasma (CCP) used early in the disease has been shown to reduce the risk of hospitalization among immunocompetent outpatients. A new randomized clinical trial from Germany supports CCP use in patients with cancer. From September 2020 to January 2022, 134 high risk patients with PCR-confirmed SARS-CoV-2 infections (mean age=69 years, 32.1% female, 11.2% fully vaccinated) were randomized to receive either standard care (n=66) or standard care in addition to two units of ABO-compatible, high titer CCP (titers >1:80) (n=68) on the day of randomization (average of 7 days after symptom onset). Four high-risk groups were evaluated: 1) cancer (n=56, hematologic and solid); 2) immunosuppression (n=16); 3) lymphopenia/elevated D-dimers (n=36); 4) age>75 years (n=26). Although no differences in outcomes were seen when all the risk-groups were combined, patients with cancer who received CCP improved more quickly (HR=2.50; P=0.003) and had increased survival compared to the control arm (HR=0.28; P=0.42). Unlike monoclonal antibodies and vaccines, convalescent plasma, has the potential to evolve in real-time with the virus and may be an important component of treating patients with cancer and COVID-19.
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