Background: The COVID-19 pandemic is expected to cause significant morbidity and mortality. The development of an effective vaccine will take several months to become available, and its affordability is unpredictable. Transfusion of convalescent plasma (CP) may provide passive immunity. Based on initial data from China, a group of hematologists, infectious disease specialists, and intensivists drafted this protocol in March 2020. Objective: The aim of this study is to test the feasibility, safety, and efficacy of CP in treating patients with COVID-19 across Saudi Arabia. Methods: Eligible patients with COVID-19 will be recruited for CP infusion according to the inclusion criteria. As COVID-19 has proven to be a moving target as far as its management is concerned, we will use current definitions according to the Ministry of Health (MOH) guidelines for diagnosis, treatment, and recovery. All CP recipients will receive supportive management including all available recommended therapies according to the available MOH guidelines. Eligible CP donors will be patients with COVID-19 who have fully recovered from their disease according to MOH recovery criteria as detailed in the inclusion criteria. CP donors have to qualify as blood donors according to MOH regulations except for the history of COVID-19 in the recent past. We will also test the CP donors for the presence of SARS-CoV-2 antibodies by a rapid test, and aliquots will be archived for future antibody titration. Due to the perceived benefit of CP, randomization was not considered. However, we will compare the outcome of the cohort treated with CP with those who did not receive CP due to a lack of consent or lack of availability. In this national collaborative study, there is a likelihood of not finding exactly matched control group patients. Hence, we plan to perform a propensity score matching of the CP recipients with the comparator group patients for the major characteristics. We plan to collect demographic, clinical, and laboratory characteristics of both groups and compare the outcomes. A total sample size of 575 patients, 115 CP recipients and 460 matched controls (1:4 ratio), will be sufficient to detect a clinically important hospital stay and 30-day mortality difference between the two groups with 80% power and a 5% level of significance. Results: At present, patient recruitment is still ongoing, and the interim analysis of the first 40 patients will be shared soon. Conclusions: In this paper, we present a protocol for a national collaborative multicenter phase II study in Saudi Arabia for assessing the feasibility, safety, and potential efficacy of CP in treating patients with severe COVID-19. We plan to publish an interim report of the first 40 CP recipients and their matched comparators soon.

Neural cell adhesion molecule (NCAM/CD56) expression in acute myeloid leukemia (AML) has been associated with extramedullary leukemia, multidrug resistance, shorter remission and survival. Recently, Bloomfield et al. published a succinct review of issues surrounding the AML prognostication and current therapeutics. However, we want to reiterate the prognostic value and therapeutic potential of CD56 that is frequently expressed in AML as was also reported by their own group earlier. In addition, novel RUNX1 isoforms contribute in controlling CD56 expression in AML cells. Anti-CD56 antibody therapy deserves exploration as an arsenal against AML patients expressing CD56. Relevantly, targeting RNA splicing machinery or RUNX1 isoform-specific siRNA may also become part of future therapeutic strategies for AML with CD56 overexpression.

We are reporting a 45-year-old woman with COVID-19 who presented to the Emergency Department with a transient loss of consciousness and was found to have a massive pulmonary embolism and an acute stroke. To our knowledge, this is the first reported case that calls for attention to the importance of vigilance for such a catastrophic presentation of COVID-19.

Acquired hemophilia is a rare autoimmune disorder that is a result of antibodies against clotting factor VIII and it presents with excessive or prolonged bleeding, often into the muscles. Thrombotic phenomena with lupus anticoagulant are common in patients with systemic lupus erythematosus (SLE). We report a rare case of a young female with no significant past medical history presenting with hematoma of the hand who was later on found to have acquired hemophilia, SLE with antiphospholipid antibodies (APLA). She was successfully treated with upfront rituximab and prednisolone leading to early and prolonged remission. No increased incidence of infections was noted. Upfront rituximab appears to be a safe and effective option in the management of such patients when compared to use of cytotoxic agents such as cyclophosphamide; however, further data from randomized studies is needed. Neutropenia and acquired hemophilia should also be considered to be listed under hematological manifestations of SLE diagnostic criteria, as they are not uncommon in such patients.

Introduction Outcomes of patients with hematological cancers and coronavirus disease 2019 (COVID-19) have been reported to be poor with high rates of hospitalization, mechanical ventilation with high case fatality rates, mortality being around 10% or higher. The mortality had been particularly higher among blacks and ethnic minority individuals. There is paucity of data on the outcomes of patients with autologous stem cell transplant and concurrent COVID-19 infections, especially from eastern mediterranean region, no similar studies have been reported so far. Methods Here we describe outcomes of five consecutive patients of middle eastern ethnic origin who had a history of autologous stem cell transplant and developed COVID-19 infection, who were admitted at our tertiary care center between April and June 2020 with a minimum of 10 days follow-up. Results A total of five patients were identified who had undergone autologous stem cell transplantation and had developed COVID-19 infection. There were 3 males and 2 females and the median age was 43 years (range 18-59). Indications for transplant were myeloma (n=3), relapsed Hodgkin lymphoma (n=1), and relapsed diffuse large b cell lymphoma (n=1). Three of five patients had other comorbidities. Median time from transplant was 9 months (range 3-33 months). Four of five patients were on active treatment or maintenance at the time of infection. One patient was on brentuximab, and three were on lenalidomide based therapy. Only one of the five patients had active disease at the time of infection while the rest were in remission. None of the patients had severe disease and four were discharged to home isolation and made full recovery, and one needed admission requiring minimal oxygen and eventually made full recovery. At a median follow up of 70 days (range 12-90) all patients were doing well with no sequelae. Conclusion Our study, albeit small, shows excellent outcomes among patients of middle eastern ethnic origin with hematological cancers who had undergone autologous stem cell transplantation and had developed COVID-19 infection, unlike other studies that have shown high mortality among patients with hematological cancers. However, our cohort is relatively younger, most of them were in remission at the time of infection which may have had a protective effect. At the same time, the majority had transplant within the last nine months and four-fifths of the patients were on some sort of immunosuppressive therapy whilst developing COVID-19 infection. It is possible that a dampened immune system due to transplant and recent therapy might have had a protective effect against cytokine storm or severe COVID-19, in our view. More studies are needed to examine this aspect further, however, these results are encouraging.