A recent publication of an exceptional case report in Blood Advances suggests that blood cancer patients may have atypical COVID-19 symptoms. The clinical findings indicate that an excessive immune response and a strong cytokine storm, which may include high levels of granulocyte-macrophage colony-stimulating factor and interleukin-6 (IL-6), are activated in severe COVID-19. A case study of a patient in Wuhan, China, suggests that the immunosuppressant tocilizumab may be an effective COVID-19 treatment for very ill patients who also have multiple myeloma and other blood cancers. 

The agent tocilizumab is commonly used to treat cytokine-release syndrome, a systemic inflammatory response that occurs in response to treatment with certain types of immunotherapies. Lead author Dr. Xuhan Zheng and colleagues suggest the agent may treat COVID-19 by addressing the acute severe inflammatory response, or "cytokine storm," that the virus triggers. However, they emphasize the need for more research into the potential mechanisms of action. In March 2020, the FDA approved a randomized, double-blind, placebo-controlled phase III clinical trial to evaluate the safety and efficacy of IV tocilizumab for the treatment of adult patients with COVID-19.

In the recently published case , the patient, a 60-year-old male who had been diagnosed with multiple myeloma in 2015 and was on maintenance therapy, was hospitalized in February for chest tightness and shortness of breath. Although he did not show symptoms of cough or fever, he tested positive for COVID-19 and his illness was categorized as severe. 

The case study publication revealed that treatment with antiviral and corticosteroid therapies did not fully resolve his symptoms. On the second day in the hospital, a chest CT scan showed that the patient had ground glass opacities in his lungs, a characteristic of pneumonia. His levels of IL-6, a proinflammatory cytokine, were elevated. After one intravenous administration of tocilizumab, the patient's IL-6 levels diminished. Three days after tocilizumab treatment, his chest tightness had resolved; 10 days later, his CT scan had cleared, and he was discharged from the hospital.

Dr. Zheng indicates that because the patient had chest tightness and shortness 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. He also states that his research team hopes this case study may offer insights and stimulate more research. 

Dr. Zheng states, “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.” 
 
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