Tocilizumab May be a Treatment Option for Patients with Hematologic Malignancies and COVID-19

In a case study published in Blood Advances, researchers detail the account of a patient with multiple myeloma (MM) and COVID-19 who was treated with the immunosuppressant tocilizumab and demonstrated gradual recovery, which the researchers said indicates “that tocilizumab is effective in the treatment of novel coronavirus infection.”

The patient was a 60-year-old man who was diagnosed with MM in 2015 and was receiving maintenance therapy. He worked in Wuhan, China, and was hospitalized in February 2020 for chest tightness and shortness of breath and subsequently tested positive for COVID-19, despite the absence of cough and fever, which are typical symptoms associated with a positive diagnosis.

Chest computed tomography (CT) scan showed multiple ground-glass opacities in the man’s lungs—characteristic of pneumonia. He also had high levels of interleukin (IL) 6.

Patient outcomes after tocilizumab treatment

The man was treated with antiviral and corticosteroid therapies, including moxifloxacin 400 mg intravenously (IV) daily for three days and umifenovir 200 mg orally three times per day. He received methylprednisone 40 mg IV daily on days two through six, after which his breathing had improved but his chest tightness remained. On day nine, the patient received a single dose of tocilizumab 8 mg/kg IV.

Tocilizumab is approved to treat cytokine release syndrome related to chimeric antigen receptor T-cell therapy.

His IL-6 levels declined gradually after tocilizumab administration over the next 10 days, from 121.59 pg/mL to 20.81 pg/mL. They then increased rapidly to 317.38 pg/mL and declined again to 117.1 pg/mL.

The man’s chest tightness resolved on day 12; by day 19, a chest CT showed decline in the range of ground-glass opacities, and he was declared “cured” and discharged from the hospital. He had no MM symptoms at this time.

“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 press release.

He also indicated that since the patient had chest tightness and shortage of breath without cough and fever, clinical symptoms of coronavirus may not follow the typical symptom pattern in patients with hematologic malignancies.

The U.S. Food and Drug Administration has since approved a randomized, double-blind, placebo-controlled, phase III trial to assess the safety and efficacy of IV tocilizumab to treat COVID-19.