Abstract
Administration of plasma therapy may contribute to viral control and survival of COVID-19 patients receiving B-cell-depleting agents that impair humoral immunity. However, little is known on the impact of anti-CD20 pre-exposition on the kinetics of SARS-CoV-2-specific antibodies. Here, we evaluated the relationship between anti-spike immunoglobulin G (IgG) kinetics and the clinical status or intra-host viral evolution after plasma therapy in 36 eligible hospitalized COVID-19 patients, pre-exposed or not to B-cell-depleting treatments. The majority of anti-CD20 pre-exposed patients (14/17) showed progressive declines of anti-spike IgG titres following plasma therapy, contrasting with the 4/19 patients who had not received B-cell-depleting agents (p = 0.0006). Patients with antibody decay also depicted prolonged clinical symptoms according to the World Health Organization (WHO) severity classification (p = 0.0267) and SARS-CoV-2 viral loads (p = 0.0032) before complete virus clearance. Moreover, they had higher mutation rates than patients able to mount an endogenous humoral response (p = 0.015), including three patients with one to four spike mutations, potentially associated with immune escape. No relevant differences were observed between patients treated with plasma from convalescent and/or mRNA-vaccinated donors. Our study emphasizes the need for an individualized clinical care and follow-up in the management of COVID-19 patients with B-cell lymphopenia.
Keywords: SARS-CoV-2; anti-CD20 therapy; antibody kinetics; convalescent plasma; immunocompromised patients; mRNA-based vaccine plasma; spike mutations; whole-genome sequencing.
【저자키워드】 convalescent plasma, SARS-CoV-2, Immunocompromised patients, anti-CD20 therapy, antibody kinetics, spike mutations, Whole-genome sequencing., mRNA-based vaccine plasma, 【초록키워드】 whole-genome sequencing, IgG, therapy, antibody, severity, clinical status, lymphopenia, Humoral immunity, survival, Immunoglobulin, Immune escape, anti-Spike IgG, viral evolution, management, Patient, Immunocompromised, plasma, WHO, Follow-up, donors, clinical care, convalescent, mutation rate, SARS-CoV-2-specific antibodies, Anti-spike, anti-CD20, B-cell, COVID-19 patient, Decline, humoral, World Health Organization, hospitalized COVID-19 patients, clinical symptom, virus clearance, SARS-CoV-2 viral load, titre, viral control, mRNA-based vaccine, Complete, evaluated, receiving, majority, contribute, impair, eligible, patients treated, 【제목키워드】 therapy, viral evolution, plasma, COVID-19 patient,