Although to date no therapies have been proven effective for treating children with life-threatening complications from COVID-19 cases that possibly may change thanks to recent findings from a small study at Children’s Hospital of Philadelphia (CHOP). The study team’s findings point out that convalescent plasma, recently approved via emergency use authorization (EUA), appears safe for children; it may possibly be effective but more randomized trials are required. Although not common, some children can become severely to critically ill with COVID-19, so the imperative is to better understand treatment options. The study was led by David Teachey, MD, attending physician, Co-Leader of the Immune Dysregulation Frontier Program and Director of Clinical Research at the Center for Childhood Cancer Research at CHOP. The results of this study were recently published in the journal Pediatric Blood and Cancer.
Challenge with Children & COVID-19
As CHOP recently published in its news release, no therapies have been proven safe and effective for children who develop life-threatening complications from COVID-19. While convalescent plasma has been studied in adults, thanks to a nationwide access program led by Mayo Clinic, an accumulation of data reveals that the therapy may in fact benefit children infected with COVID-19.
However, the Mayo led initiative was not a randomized controlled trial and the government was mixed as to implementing the EUA. In fact, factions within the National Institutes of Health (NIH) sought to hold off on any EUA for more analysis—and possibly more data. In the end, a more conservative minded group didn’t prevail and the FDA made their announcement to greenlight the EUA.
But that, of course, wasn’t applicable for children.
Small but Important Study
This is actually a first in that it’s a first report of convalescent plasma in children with life-threatening COVID-19, while involving research across a wide range of disciplines, from immune dysregulation, transfusion medicine, infectious disease and many more. Although a very small study (only four patients), the children had developed acute respiratory distress syndrome (ARDS). Both prior to, and after the study, the researchers measured donor antibody levels and recipient antibody response before the infusion of convalescent plasma in a systematic effort to determine if there were any adverse reactions in the children.
CHOP reported that using convalescent plasma wasn’t associated with antibody-dependent enhancement (e.g. antibodies developed due to previous infection) and this investigational therapy didn’t “suppress endogenous antibody response.”
Lead investigator Dr. Teachey reported, “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.” The CHOP investigator continued, “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 with COVID-19.”
The study was supported by a number of number of funders, from the National Institute of Allergy and Infectious Diseases (NIAID), to private foundations and medical associations.
David Teachey, MD, attending physician, Co-Leader of the Immune Dysregulation Frontier Program and Director of Clincial Research at the Center for Childhood Cancer Research at CHOP
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
Hamid Bassiri, MD, PhD, Division of Infectious Diseases
Caroline Diorio, MD, FRCPC, FAAP
Call to Action: More randomized controlled trials will be needed to further expand on the knowledge generated from this study—the CHOP team is to be commended for their work focusing on this group.