Physicians Successfully Treat Severe COVID-19 in Patient With Multiple Myeloma

In the epicenter of the coronavirus disease 2019 (COVID-19) Wuhan, China – 60-year-old patient with multiple myeloma (MM) presented with chest tightness with no fever or cough, in early February. The patient was successfully treated with the anti-interleukin (IL)-6 receptor antibody tocilizumab (Acetemra), according to a case study published in Blood Advances.¹

The Threat of COVID-19 for Patients with MM

Like all malignancies, patients with MM have compromised immune systems, which puts them at a higher risk for contracting COVID-19 than the average person. Patients with MM also experience treatment difficulties, making it difficult for their physicians to bring them to cure.

"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 Changcheng Zheng, MD, of the University of Science and Technology of China and the study's lead author, in a statement.²

Prior research on COVID-19 has also found that the presence of comorbidities, in general, can mask the recognizable symptoms of COVID-19. This was the case for the patient with MM in Wuhan.¹

Diagnosis and Treatment COVID-19 in a Patient with MM

In the case description, the study authors explained the initial treatment of the patient after his mildly symptomatic illness was diagnosed as severe COVID-19. First, Zheng et al described the process of diagnosing the virus.

Using computed typography, the patient’s chest was scanned and displayed evidence of multiple ground-glass opacities and pneumatocele, which were positioned in both subpleural regions of the lungs. As a first treatment, moxifloxacin 400 mg was administered intravenously (IV) for 3 days. Initial treatment did not significantly diminish the patient’s symptoms and further diagnostics were done.

Nasopharyngeal swab specimens were taken to confirm whether severe acute respiratory syndrome coronavirus 2 (SARS-coV-2) nucleic acid was present in the patient. A real-time reverse transcriptase-polymerase chain reaction was used to determine the results of the test, and after 3 days, it was revealed that the patient was positive for COVID-19.

As a second attempt at treatment, an anti-viral drug, umifenovir (Arbidol) 200 mg was administered 3 times daily. The patient continued to show high levels of IL-6, a pro-inflammatory cytokine, however.

The case worsened on February 16th, when shortness of breath caused by decreased arterial oxygen saturation (∼93% at rest) was added to the patient’s list of symptoms. The patient was transferred to another unit of Wuhan Union Hospital where laboratory tests were taken. The tests showed lymphocytopenia (0.89 × 10⁹/L), and although other lab values were normal, the patient’s illness was classified as severe.

Tocilizumab at 8 mg/kg was administered to the patient after day 9 in the hospital. Over a 10-day period, physicians could see a gradual decrease in his IL-6 level. It climbed as high as 317.38 pg/mL, but eventually lowered to 117.10 pg/mL. The study authors noted that this decrease was a sign of recovery of the normal T cells rather than COVID-19 relapse.

A third chest scan was conducted on day 19 of being in the hospital. The scan revealed a decrease in the range of ground-glass opacities that were concerning in the initial CT scan. On March 13, 2020, physicians determined that the patient had been cured of COVID-19 and he was discharged from Wuhan Union Hospital with no symptoms of either disease.

Based on this case, considering the lack of MM symptoms at the time the patient was discharged from the hospital, Zheng et al held that tocilizumab may also be a beneficial immunotherapy drug for patients with MM in the future.

“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,” said Zheng.²

_References:

_{1. Zhang X, Song K, Tong F, Fei M, Guo H, Lu Z, Wang J, and Zheng C. First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab.Blood Adv.2020;4(7):1307-1310. doi: 10.1182/bloodadvances.2020001907.}

_{2. Case study: treating covid-19 in a patient with multiple myeloma [news release]. Washington, DC: American Society of Hematology; April 3, 2020.https://prn.to/3c2dDIm. Accessed April 10, 2020.}