key: cord-0988665-608pn0kw
authors: Zhang, Lu-Lu; Liu, Yu; Guo, Yi-Gang; Chang, Juan; Gao, Bo; Li, Zhang-Zhi; Geng, Wei; Hu, Pin; Song, Bin; Zhang, Xia; Wan, Chu-Cheng
title: Convalescent Plasma Rescued a Severe COVID-19 Patient with Chronic Myeloid Leukemia Blast Crisis and Myelofibrosis
date: 2021-02-25
journal: Turk J Haematol
DOI: 10.4274/tjh.galenos.2020.2020.0400
sha: 5a4904a94ab88189703c3c63b487d642d48da6c9
doc_id: 988665
cord_uid: 608pn0kw

nan

Coronavirus disease-2019 (COVID-19) is now an unprecedented worldwide pandemic. However, there are no specific antiviral drugs available for its treatment. A handful of studies have summarized convalescent plasma (CP) transfusion in severe or critical cases [1, 2, 3, 4, 5, 6] , whereas therapies for COVID-19 in cases of hematologic cancer are rather limited. We give the first report of the initial clinical experience with CP transfusion administered to a severe COVID-19 patient with chronic myeloid leukemia blast crisis (CML-BP) and myelofibrosis.

A 46-year-old female patient presented with diarrhea, a cough with clear sputum, and fatigue for 3 days. Her previous history of treatment for CML-BP consisted of daunorubicin at 45 mg/m 2 for 3 days and cytarabine at 200 mg/m 2 for 7 days in a continuous infusion, and then she experienced discontinuation of the tyrosine kinase inhibitor therapy. She was given imatinib (600 mg/day) starting in November 2017, but a drug-related hematologic adverse event occurred quickly. As a result, dasatinib (150 mg/day) was given instead. She had not achieved complete hematological remission at the diagnosis of COVID-19 due to poor responses to these therapies. At admission (February 21, 2020), the most relevant clinical findings included white blood cell count of 4.93x109/L with 78% neutrophils, 9.2% lymphocytes, 2.3% basophils, 0.4% eosinophils, and 10.1% monocytes; hemoglobin of 51 g/L; platelet count of 79x109/L; high-sensitivity C-reactive protein of 57.43 mg/L; and interleukin-6 level of 59.25 pg/mL. The real-time polymerase chain reaction (RT-PCR) assay of the throat swab was positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. A chest CT obtained on February 21 revealed bilateral ground-glass opacities primarily distributed along the pleura (Figures 1a and 1d) . Bone marrow examination The patient developed worsening hypoxemia, with oxyhemoglobin saturation (SaO 2 ) oscillating between 90% and 93%, after receiving conventional antiviral therapy including arbidol (200 mg three times daily), oseltamivir (75 mg twice daily), ribavirin (500 mg every 12 hours), and interferon-alpha-2b inhalation (5 million units twice daily). A follow-up chest CT scan showed increased consolidation and extended opacities (Figures 1b and 1e) . On February 26, the patient received a transfusion of 200 mL of CP obtained from a donor who had recovered from SARS-CoV-2 infection in January 2020 with the neutralizing antibody titer above 1:640. No immediate adverse reactions were observed after plasma infusion. One day later, her SaO 2 increased to 98% with oxygenation index of 200 mmHg. At the same time, her clinical symptoms and pathological criteria improved rapidly within 3 days. The patient's condition improved to stable; thus, treatment with pulsed dasatinib was administered (100 mg once daily). Three repetitive RT-PCR tests were negative from the 6 th to 8 th day after CP transfusion. Chest images showed absorption of opacities within 10 days (Figures  1c and 1f) . The patient recovered and was discharged on the 14 th day of admission. A recent study showed a 10% case rate of COVID-19 among 128 patients with hematological cancers in Wuhan [7] . The treatment of severe COVID-19 has been challenging. This pilot study on CP therapy shows that it can serve as a promising rescue option for hematologic cancer patients with severe COVID-19, which warrants further investigation by randomized trials. 

Effectiveness of convalescent plasma therapy in severe COVID-19 patients

Severe acute respiratory syndrome coronavirus 2 neutralizing antibody titers in convalescent plasma and recipients in New Mexico: an open treatment study in patients with coronavirus disease 2019

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

Treatment with convalescent plasma for critically ill patients with severe acute respiratory syndrome coronavirus 2 infection

Improved clinical symptoms and mortality among patients with severe or critical COVID-19 after convalescent plasma transfusion

Convalescent plasma as a potential therapy for COVID-19

COVID-19 in persons with haematological cancers