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Association of Convalescent Plasma Therapy With Survival in Patients With Hematologic Cancers and COVID-19

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Is convalescent plasma therapy associated with improved outcomes of hospitalized patients with COVID-19 and hematologic cancer?

Findings  In this cohort study of 966 patients with hematologic cancer and COVID-19, after adjustment for potential confounding factors, convalescent plasma treatment was associated with a significantly improved 30-day mortality in the 143 individuals who received it. This association remained significant after propensity score matching.

Meaning  These findings suggest a potential survival benefit in the administration of convalescent plasma to patients with hematologic cancers and COVID-19.

Abstract

Importance  COVID-19 is a life-threatening illness for many patients. Prior studies have established hematologic cancers as a risk factor associated with particularly poor outcomes from COVID-19. To our knowledge, no studies have established a beneficial role for anti–COVID-19 interventions in this at-risk population. Convalescent plasma therapy may benefit immunocompromised individuals with COVID-19, including those with hematologic cancers.

Objective  To evaluate the association of convalescent plasma treatment with 30-day mortality in hospitalized adults with hematologic cancers and COVID-19 from a multi-institutional cohort.

Design, Setting, and Participants  This retrospective cohort study using data from the COVID-19 and Cancer Consortium registry with propensity score matching evaluated patients with hematologic cancers who were hospitalized for COVID-19. Data were collected between March 17, 2020, and January 21, 2021.

Exposures  Convalescent plasma treatment at any time during hospitalization.

Main Outcomes and Measures  The main outcome was 30-day all-cause mortality. Cox proportional hazards regression analysis with adjustment for potential confounders was performed. Hazard ratios (HRs) are reported with 95% CIs. Secondary subgroup analyses were conducted on patients with severe COVID-19 who required mechanical ventilatory support and/or intensive care unit admission.

Results  A total of 966 individuals (mean [SD] age, 65 [15] years; 539 [55.8%] male) were evaluated in this study; 143 convalescent plasma recipients were compared with 823 untreated control patients. After adjustment for potential confounding factors, convalescent plasma treatment was associated with improved 30-day mortality (HR, 0.60; 95% CI, 0.37-0.97). This association remained significant after propensity score matching (HR, 0.52; 95% CI, 0.29-0.92). Among the 338 patients admitted to the intensive care unit, mortality was significantly lower in convalescent plasma recipients compared with nonrecipients (HR for propensity score–matched comparison, 0.40; 95% CI, 0.20-0.80). Among the 227 patients who required mechanical ventilatory support, mortality was significantly lower in convalescent plasma recipients compared with nonrecipients (HR for propensity score–matched comparison, 0.32; 95% CI, 0.14-0.72).

Conclusions and Relevance  The findings of this cohort study suggest a potential survival benefit in the administration of convalescent plasma to patients with hematologic cancers and COVID-19.

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Article Information

Accepted for Publication: April 14, 2021.

Published Online: June 17, 2021. doi:10.1001/jamaoncol.2021.1799

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Thompson MA et al. JAMA Oncology.

Corresponding Author: Jeremy L. Warner, MD, MS, Division of Hematology/Oncology, Vanderbilt University, 2220 Pierce Ave, 777 PRB, Nashville, TN 37232 (jeremy.warner@vumc.org).

Author Contributions: Dr Warner had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Thompson and Henderson contributed equally. Drs D. P. Shah and Warner contributed equally

Concept and design: Thompson, Henderson, Rubinstein, Joyner, Choueiri, Xie, D. P. Shah, Warner.

Acquisition, analysis, or interpretation of data: Thompson, Henderson, P. Shah, Rubinstein, Choueiri, Flora, Griffiths, Gulati, Hwang, Koshkin, Papadopoulos, Robilotti, Su, Wulff-Burchfield, Xie, Yu, Mishra, Senefeld, D. P. Shah, Warner.

Drafting of the manuscript: Thompson, Henderson, P. Shah, Rubinstein, Joyner, Griffiths, Xie, Yu, D. P. Shah, Warner.

Critical revision of the manuscript for important intellectual content: Thompson, Henderson, Rubinstein, Choueiri, Flora, Griffiths, Gulati, Hwang, Koshkin, Papadopoulos, Robilotti, Su, Wulff-Burchfield, Xie, Yu, Mishra, Senefeld, D. P. Shah, Warner.

Statistical analysis: P. Shah, D. P. Shah.

Obtained funding: Henderson, Warner.

Administrative, technical, or material support: Thompson, Joyner, Choueiri, Flora, Griffiths, Hwang, Koshkin, Wulff-Burchfield, Yu, Mishra.

Supervision: Thompson, Henderson, Choueiri, Senefeld, D. P. Shah, Warner.

Conflict of Interest Disclosures: Dr Thompson reported receiving personal fees from Adaptive, BMS, Elsevier, Epizyme, Takeda, and AIM Specialty Health, royalties from UpToDate, personal fees from GRAIL/Illumina, and nonfinancial support (travel) from Syapse outside the submitted work. Dr Henderson reported receiving personal fees from Immunome outside the submitted work. Dr P. Shah reported receiving grants from the Biomedical Advanced Research and Development Authority during the conduct of the study. Dr Choueiri reported receiving nonfinancial support from the COVID-19 and Cancer Consortium, the European Society of Medical Oncology COVID-19 Registry for Patients With Cancer, and the COVID-19 and Cancer Outcomes Study during the conduct of the study and receiving honoraria from Pfizer, Exelixis, BMS, Merck, Roche/Genentech, Novartis, and Lilly and royalties for UpToDate outside the submitted work. Dr Griffiths reported receiving personal fees from Takeda Oncology, AbbVie, Novartis Pharmaceuticals, Celgene/BMS, Alexion Pharmaceuticals, and Boston Biomedical, nonfinancial support from Appelis Pharmaceuticals, and grants from Genentech outside the submitted work. Dr Hwang reported receiving grants from Merck, Exelixis, Bayer, AstraZeneca, Genentech, Dendreon, and Bausch, personal fees from Sanofi/Genzyme, Exelixis, Bristol Myers Squibb, Astellas, Medivation, Bayer, and Janssen Scientific, and owning stock in Johnson and Johnson outside the submitted work. Dr Koshkin reported receiving personal fees from AstraZeneca, Clovis, Janssen, Pfizer, EMD Serono, Seattle Genetics/Astellas, and Dendreon and grants from Endocyte, Nektar, Clovis, Taiho, and Janssen outside the submitted work. Dr Wulff-Burchfield reported receiving personal fees from Exelixis, BMS Consulting, and Pfizer Global and having a family member with stock ownership in Immunomedics and Nektar outside the submitted work. Dr Mishra reported receiving grants from the National Cancer Institute during the conduct of the study. Dr Senefeld reported having a contract with the Biomedical Advanced Research and Development Authority during the conduct of the study. Dr D. P. Shah reported receiving grants from the Biomedical Advanced Research and Development Authority, American Cancer Society, and Hope Foundation for Cancer Research during the conduct of the study. Dr Warner reported receiving grants from the National Cancer Institute during the conduct of the study, nonfinancial support from HemOnc.org LLC, and personal fees from Westat and IBM Watson Oncology outside the submitted work. No other disclosures were reported.

Funding/Support: This project has been funded in whole or in part with federal funds from the US Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority under contract 75A50120C00096 (Drs Joyner, P. Shah, and D. P. Shah); National Cancer Institute grants P30 CA008748 (Drs Robilloti and Papadopolous), P30 CA046592 (Dr Su), P30 CA054174 (Drs P. Shah and D. P. Shah), P30 CA068485 (Drs Warner and Mishra), T32 CA236621 (Dr Su), and U01 CA231840 (Dr Warner); National Center for Advancing Translational Sciences grant UL1 TR002377 (Dr Joyner); Schwab Charitable Fund (Eric E. Schmidt, Wendy Schmidt, donors) (Dr Joyner); United Health Group (Dr Joyner); National Basketball Association (Dr Joyner); Millennium Pharmaceuticals (Dr Joyner); Octapharma USA Inc (Dr Joyner); grant MRSG-16-152-01-CCE from the American Cancer Society and Hope Foundation for Cancer Research (Dr. P. Shah); the Longer Life Foundation: A RGA/Washington University Partnership (Dr Henderson); and the Mayo Clinic (Drs Joyner and Senefeld). REDCap is developed and supported by the Vanderbilt Institute for Clinical and Translational Research under grant UL1 TR000445 from National Center for Advancing Translational Sciences/National Institutes of Health.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: A complete list of members of the COVID-19 and Cancer Consortium at sites contributing to this analysis appears in Supplement 2.

Disclaimer: The views and opinions expressed in this publication are those of the authors and do not reflect the official policy or position of the US Department of Health and Human services and its agencies, including the Biomedical Research and Development Authority and the US Food and Drug Administration, as well as any agency of the US government. Assumptions made within and interpretations from the analysis are not reflective of the position of any US government entity.

Additional Contributions: We thank all members of the CCC19 steering committee: Toni K. Choueiri, Narjust Duma, Dimitrios Farmakiotis, Petros Grivas, Gilberto de Lima Lopes Jr, Corrie A. Painter, Solange Peters, Brian I. Rini, Dimpy P. Shah, Michael A. Thompson, and Jeremy L. Warner, for their invaluable guidance of the CCC19 consortium. A list of individuals who made substantial contributions to data collection is provided in the eAppendix in Supplement 1; these contributions were uncompensated.

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