Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Pediatric Oncology and Hematology, Children's Hospital of Minnesota, Minneapolis, Minnesota, USA.
Transfusion. 2021 Aug;61(8):2503-2511. doi: 10.1111/trf.16525. Epub 2021 Jun 1.
In the absence of effective countermeasures, human convalescent plasma has been widely used to treat severe acute respiratory syndrome coronavirus 2, the causative agent of novel coronavirus disease 19 (COVID-19), including among patients with innate or acquired immunosuppression. However, the association between COVID-19-associated mortality in patients with immunosuppression and therapeutic use of convalescent plasma is unknown. We review 75 reports, including one large matched-control registry study of 143 COVID-19 patients with hematological malignancies, and 51 case reports and 23 case series representing 238 COVID-19 patients with immunosuppression. We review clinical features and treatment protocols of COVID-19 patients with immunosuppression after treatment with human convalescent plasma. We also discuss the time course and clinical features of recovery. The available data from case reports and case series provide evidence suggesting a mortality benefit and rapid clinical improvement in patients with several forms of immunosuppression following COVID-19 convalescent plasma transfusion. The utility of convalescent plasma or other forms of antibody therapy in immune-deficient and immune-suppressed patients with COVID-19 warrants further investigation.
在缺乏有效对策的情况下，人类恢复期血浆已被广泛用于治疗严重急性呼吸综合征冠状病毒 2，即新型冠状病毒病 19（COVID-19）的病原体，包括先天或后天免疫抑制的患者。然而，免疫抑制患者 COVID-19 相关死亡率与恢复期血浆治疗之间的关联尚不清楚。我们复习了 75 份报告，包括对 143 例血液恶性肿瘤 COVID-19 患者的一项大型匹配对照登记研究，以及 51 例病例报告和 23 例病例系列，共涉及 238 例免疫抑制 COVID-19 患者。我们复习了 COVID-19 免疫抑制患者接受人恢复期血浆治疗后的临床特征和治疗方案。我们还讨论了恢复的时间过程和临床特征。病例报告和病例系列中的现有数据提供了证据，表明 COVID-19 恢复期血浆输注后，多种形式免疫抑制患者的死亡率降低，临床改善迅速。恢复期血浆或其他形式的抗体治疗在 COVID-19 免疫缺陷和免疫抑制患者中的应用价值需要进一步研究。
