A case study of one patient with multiple myeloma diagnosed with COVID-19 in Wuhan, China, published by Zhang et al in Blood Advances examined the efficacy of the immunosuppressant tocilizumab as a treatment for this particular patient. The report also suggested that patients with hematologic malignancies may have atypical COVID-19 symptoms.

“Our patients with hematologic malignancies are immunosuppressed, which may put them at higher risk for novel coronavirus infection. What are the characteristics of COVID-19 in patients with blood cancers? What is the optimal treatment approach? Everything is unknown, and that was the motivation for this study,” said lead study author Changcheng Zheng, MD, of the University of Science and Technology of China, in a statement.

Case Study

The patient—a 60-year-old male who had been diagnosed with multiple myeloma in 2015, was treated with two cycles of induction triplet chemotherapy, and was on maintenance thalidomide therapy—was hospitalized in February for chest tightness and shortness of breath. Although he did not show symptoms of cough or fever, he did have decreased oxygen saturation, diminished breath sounds in his lower left lung, and lymphocytopenia. He tested positive for COVID-19, and his illness was classified as severe.

Treatment with antiviral and corticosteroid therapies did not fully resolve his symptoms. On the second day in the hospital, a chest computed tomography (CT) scan showed that the patient had ground glass opacities in his lungs—a characteristic of pneumonia. His levels of interleukin-6 (IL-6), a proinflammatory cytokine, were high.

After one intravenous administration of tocilizumab, the patient’s IL-6 levels decreased. Three days after tocilizumab treatment, his chest tightness had resolved; 10 days later, his CT scan showed decreased range of ground-glass opacities, and he was discharged from the hospital.

Possible Mechanism

Tocilizumab is commonly used to treat cytokine-release syndrome, a systemic inflammatory response that occurs in response to treatment with certain types of immunotherapies. Dr. Zheng and his team suggested the agent may treat COVID-19 by addressing the acute severe inflammatory response, or “cytokine storm,” that the virus can trigger. However, they emphasize the need for more research into the potential mechanisms of action.

Dr. Zheng also suggests 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.

“Tocilizumab was effective in the treatment of COVID-19 in this patient with multiple myeloma, but further prospective and randomized clinical trials are needed to verify the findings,” concluded Dr. Zheng.

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

Disclosure: For full disclosures of the study authors, visit ashpublications.org/bloodadvances.