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Patient-blood management for COVID19 convalescent plasma therapy: relevance of affinity and donor–recipient differences in concentration of neutralizing antibodies


Focosi, Daniele; Maggi, Fabrizio; Franchini, Massimo; Aguzzi, Adriano; Lanza, Maria; Mazzoni, Alessandro; Menichetti, Francesco (2021). Patient-blood management for COVID19 convalescent plasma therapy: relevance of affinity and donor–recipient differences in concentration of neutralizing antibodies. Clinical Microbiology and Infection, 27(7):987-992.

Abstract

Background: Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) is being extensively investigated as a treatment, with mixed results to date. Overall, there has been a generalized lack of appropriateness in prescriptions, which, in the field of transfusion medicine, is termed patient-blood management.
Objectives: We aimed to separate study design variables that could affect clinical outcome after CCP therapy. We focus here on variables such as pretransfusion antibody testing in recipients, dose adjustments and antibody affinity measurements.
Sources: We searched PubMed and preprint servers for relevant preclinical and clinical studies discussing each of these variables in the field of CCP therapy.
Content: We show evidence that neglecting those variables has affected the outcomes of the vast majority of CCP clinical trials to date.
Implications: A better understanding of such variables will improve the design of the next generation of CCP clinical trials. This will likely lead to better clinical outcomes and will minimize risks of immune evasion from subneutralizing doses of neutralizing antibodies.

Keywords: Convalescent plasma; Coronavirus disease 2019; Neutralizing antibodies; Pharmacodynamics; Stoichiometry.

Abstract

Background: Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) is being extensively investigated as a treatment, with mixed results to date. Overall, there has been a generalized lack of appropriateness in prescriptions, which, in the field of transfusion medicine, is termed patient-blood management.
Objectives: We aimed to separate study design variables that could affect clinical outcome after CCP therapy. We focus here on variables such as pretransfusion antibody testing in recipients, dose adjustments and antibody affinity measurements.
Sources: We searched PubMed and preprint servers for relevant preclinical and clinical studies discussing each of these variables in the field of CCP therapy.
Content: We show evidence that neglecting those variables has affected the outcomes of the vast majority of CCP clinical trials to date.
Implications: A better understanding of such variables will improve the design of the next generation of CCP clinical trials. This will likely lead to better clinical outcomes and will minimize risks of immune evasion from subneutralizing doses of neutralizing antibodies.

Keywords: Convalescent plasma; Coronavirus disease 2019; Neutralizing antibodies; Pharmacodynamics; Stoichiometry.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Neuropathology
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Scopus Subject Areas:Health Sciences > Microbiology (medical)
Health Sciences > Infectious Diseases
Uncontrolled Keywords:Microbiology (medical), Infectious Diseases, General Medicine, COVID-19
Language:English
Date:1 July 2021
Deposited On:16 Jun 2021 12:43
Last Modified:25 Jun 2024 01:40
Publisher:Elsevier
ISSN:1198-743X
OA Status:Closed
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.cmi.2021.04.003
PubMed ID:33878505