Case Study Shows Efficacy from Tocilizumab in Patient With COVID-19, Myeloma

A case study of a patient in Wuhan, China, published in Blood Advances, found that tocilizumab (Actemra) may be an effective treatment for very ill patients with coronavirus disease 2019 (COVID-19) who also have multiple myeloma and other blood cancers.¹

The report also indicated that patients with blood cancer may have atypical COVID-19 symptoms.

“Our patients with hematologic malignancies are immunosuppressed, which may put them at higher risk for novel coronavirus infection,” lead author Changcheng Zheng, MD, of the University of Science and Technology of China, said in a press release.² “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.”

The study subject, a 60-year-old man working in Wuhan, China who had been diagnosed with multiple myeloma in 2015 and was on maintenance therapy, was hospitalized in February after computed tomography (CT) imaging of his chest showed multiple ground-glass opacities and pneumatocele located in both subpleural spaces. Although he did not show symptoms of cough or fever, he did indicate that he experienced chest tightness and shortness of breath. 

Swab specimens confirmed a positive result of COVID-19, however, treatment with antiviral and corticosteroid therapies did not fully resolve his symptoms. Moreover, chest CT imaging on day 8 of the patient’s hospital stay showed that bilateral, multiple ground-glass opacities from the first scan remained, and laboratory investigations also revealed a high level of serum IL-6. 

On hospital day 9, the patient was given 8 mg/kg of tocilizumab, administered by IV, 1 time. By hospital day 12, the tightness in his chest had disappeared. Further, after tocilizumab administration, the IL-6 level decreased gradually over the following 10 days (from 121.59 to 20.81 pg/mL), then increased rapidly to the peak (317.38 pg/mL), and then decreased to a low level (117.10 pg/mL). 

“The transient rebounding of the IL-6 level to the peak does not mean COVID-19 relapse,” the authors wrote. “Instead, this might be attributed to the recovery of the normal T cells.” 

On hospital day 19, the patient had a third chest CT scan, which found that the range of ground-glass opacities had obviously decreased. The patient was declared to be cured and was discharged from the hospital shortly after. Notably, he had no symptoms of multiple myeloma, and related laboratory findings were all within normal ranges.

Tocilizumab is often used to treat cytokine release syndrome, an inflammatory response that occurs in response to treatment with some types of immunotherapies. Researchers suggest that the agent may treat COVID-19 by addressing the cytokine storm that the virus triggers, however they also suggest the need for more research into the potential mechanisms of action. 

“Our patient’s clinical conditions gradually recovered after tocilizumab treatment, indicating that tocilizumab is effective in the treatment of novel coronavirus infection,” the authors wrote. “IL-6 signaling plays a crucial role in the pathogenesis of (multiple myeloma; MM), and small molecule inhibitors targeting IL-6 signaling are highly effective at preventing MM cell growth.”

“We speculate that tocilizumab might also have potential benefit for MM as an immunotherapy in the future. This case is the first to prove that tocilizumab is effective in the treatment of COVID-19 in MM with obvious clinical recovery; however, randomized controlled trials are needed to determine the safety and efficacy of tocilizumab.”

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

References:

1. Zhang X, Song K, Tong F, et al. First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab. Blood Advances. doi:10.1182/bloodadvances.2020001907.

2. Case Study: Treating COVID-19 in a Patient with Multiple Myeloma [news release]. Washington. Published April 3, 2020. hematology.org/newsroom/press-releases/2020/case-study-treating-covid-19. Accessed April 7, 2020.