Case Study Reveals Patients With Hematological Malignancies May Benefit From Tocilizumb for COVID-19 Symptoms

A case study of a patient in Wuhan, China, suggests that the immunosuppressant tocilizumab may be an effective coronavirus disease 2019 (COVID-19) treatment for patients who also have multiple myeloma and other blood cancers.

Published in Blood Advances, the report also suggests that patients with blood cancer may have atypical COVID-19 symptoms.

The motivations for the study centered on concerns that patients with hematologic malignancies are immunosuppressed, placing them at higher risk for the COVID-19 infection.

The patient, a 60-year-old male diagnosed with multiple myeloma in 2015 and on maintenance therapy, was hospitalized in February for chest tightness and shortness of breath. Although he did not show symptoms of cough or fever, he tested positive for COVID-19 and his illness was classified as severe.

According to a press release, treatment with antiviral and corticosteroid therapies did not fully resolve his symptoms. On day 2 in the hospital, a chest CT scan showed that the patient had ground glass opacities in his lungs, characteristic of pneumonia. Additionally, interleukin-6 (IL-6) levels were high. After 1 intravenous administration of tocilizumab, the patient's IL-6 levels decreased. Three days after tocilizumab treatment, his chest tightness had resolved. Ten days after that, his CT scan had cleared and he was discharged from the hospital.

Tocilizumab is used to treat cytokine release syndrome, a systemic inflammatory response that occurs in response to treatment with certain types of immunotherapies. The researchers suggest the agent may treat COVID-19 by addressing the acute severe inflammatory response, or "cytokine storm," that the virus triggers, according to the press release. However, the study authors emphasized the need for more research into the potential mechanisms of action.

The researchers also suggest that because the patient had chest tightness and shortage of breath without other COVID-19 symptoms, specifically cough and fever, clinical symptoms of the virus may not be typical in patients who have hematologic malignancies.

The study authors said this case study may offer insights and stimulate more research.

In March 2020, the FDA approved a randomized, double-blind, placebo-controlled phase 3 clinical trial to evaluate the safety and efficacy of intravenous tocilizumab for the treatment of adult patients with COVID-19.

Reference

• Case Study: Treating COVID-19 in a Patient with Multiple Myeloma [news release]. American Society of Hematology website. Published April 3, 2020. https://www.hematology.org/newsroom/press-releases/2020/case-study-treating-covid-19. Accessed April 7, 2020.