COVID-19 and Multiple Myeloma: 60-Year-Old Man Successfully Treated With Tocilizumab
Posted: Wednesday, May 20, 2020
A noteworthy case of COVID-19 in a patient with multiple myeloma, who ultimately responded to tocilizumab, was described in a profile published in Blood Advances. Although treatment was successful, Changcheng Zheng, MD, of The First Affiliated Hospital of University of Science and Technology of China, and colleagues noted that randomized controlled trials are necessary to evaluate the efficacy and safety of the drug in patients with such comorbidities.
“Small-molecule inhibitors targeting IL-6 [interleukin6] signaling are highly effective at preventing multiple myeloma cell growth,” explained the study authors. “We speculate that tocilizumab might also have potential benefit for multiple myeloma as an immunotherapy in the future.”
A 60-year-old man undergoing thalidomide maintenance for symptomatic multiple myeloma was admitted to the hospital after experiencing chest tightness and shortness of breath. A chest CT revealed ground-glass opacities and pneumatocele in both subpleural spaces, and he was subsequently diagnosed with COVID-19. The patient received methylprednisolone for his respiratory symptoms. He reported he was still experiencing chest tightness after treatment, as the ground-glass opacities had not yet resolved. Laboratory assessments confirmed increased serum IL-6 levels consistent with severe COVID-19 infection.
The patient was given 8 mg/kg of tocilizumab once on day 9. Three days later, he reported resolution of his chest tightness. His IL-6 level progressively decreased (121.59 pg/mL to 20.81 pg/mL), however, it transiently peaked prior to further declination (317.38 pg/mL to 117.10 pg/mL). The authors noted this brief increase was not likely due to COVID-19, but rather normal T-cell recovery. The patient was discharged after a CT revealed a decrease in ground-glass opacities. His laboratory parameters all returned to normal, and he did not experience any multiple myeloma symptoms.
Disclosure: The study authors reported no conflicts of interest.