Small study shows convalescent plasma is safe to use in pediatric patients with COVID-19

To date, no therapies have been proven safe and effective for children who develop life-threatening complications from contracting the SARS-COV-2 virus. One possible treatment that has been explored in adults is the use of convalescent plasma, which is derived from patients who have recovered from COVID-19 and can be administered in currently ill patients to generate an antibody response that renders the virus inert. Early positive results were observed in adults who received convalescent plasma, but the treatment had not been studied in children.

"Some children who contract this virus can develop very serious complications, so even with limited data in adults, we believed it was worth exploring the use of convalescent plasma as a possible treatment option," said David Teachey, MD, senior author of the study and an attending physician, Co-Leader of the Immune Dysregulation Frontier Program, and Director of Clinical Research at the Center for Childhood Cancer Research at CHOP.

This study is the first report of convalescent plasma in children with life-threatening COVID-19 and involved researchers in a wide variety of disciplines, including immune dysregulation, transfusion medicine, infectious disease, occupational health, critical care, hematology, oncology, immunology, and rheumatology. The study involved four patients with acute respiratory distress syndrome. The researchers measured donor antibody levels and recipient antibody response prior to and following the convalescent plasma infusion to determine whether there were any adverse reactions.

In the four patients that were studied, the use of convalescent plasma was not associated with antibody-dependent enhancement, in which antibodies developed during a previous infection cause a worsened response with subsequent infections, a concern that has been described in preclinical models of other coronaviruses. Additionally, convalescent plasma did not suppress endogenous antibody response.

"We believe that convalescent plasma may provide the greatest benefit for patients who are early into their illness and have not yet generated endogenous antibodies," Teachey said. "While the small sample size of our study does not allow us to draw any definitive conclusions, we believe this method is safe and future research should include randomized controlled trials to more definitively examine how effective convalescent plasma may be in treating children infected with COVID-19."

Among Teachey's colleagues contributing to this research are Deborah Sesok-Pizzini, MD, MBA, medical director of Blood Bank and Transfusion Medicine; Edward Behrens, MD, chief, Division of Rheumatology and co-leader, Immune Dysregulation Frontier Program; Kathleen Chiotos, MD, Pediatric Sepsis Program; and Hamid Bassiri, MD, PhD, in the Division of Infectious Diseases; all of whom hold faculty positions at the Perelman School of Medicine at the University of Pennsylvania, as well as Caroline Diorio, MD, FRCPC, FAAP, fellow with the Cancer Center at CHOP.

Support for this study was provided by the CHOP Frontiers Program Immune Dysregulation; the National Institute of Allergy and Infectious Diseases grants R01AI121250, R01AI103280, R01AI123433, R21AI144472, K08 AI136660, and K08AI135091; the Agency for Healthcare Research and Quality grant 5K12HS026393; the National Cancer Institute grants R01CA193776, X01HD100702-01, 5UG1CA233249, and R01A1123538; a NIH Training in Virology grant T32-AI-007324; the Leukemia and Lymphoma Society; Cookies for Kids Cancer; Alex's Lemonade Stand Foundation for Childhood Cancer; Children's Oncology Group; Stand UP 2 Cancer; Team Connor; Kate Amato Foundations; Burroughs Wellcome Fund CAMS and PATH; Clinical Immunology Society; and the American Academy of Allergy, Asthma, and Immunology.

Serological studies were supported by institutional funds from the University of Pennsylvania. Additional support was provided by the Institute for Translational Medicine and Therapeutics of the Perelman School of Medicine at the University of Pennsylvania.