案例研究：在多發性骨髓瘤患者中治療COVID-19 Case study: Treating COVID-19 in a patient with multiple myeloma

News Release 3-Apr-2020

Tocilizumab shows promise in addressing COVID-19 symptoms for people with blood cancers

American Society of Hematology

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 report, published in Blood Advances, also suggests that blood cancer patients may have atypical COVID-19 symptoms.

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 classified as severe.

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, which are a characteristic of pneumonia. His levels of interleukin-6 (IL-6), a pro-inflammatory cytokine, were high. After one intravenous administration of tocilizumab, the patient’s IL-6 levels decreased. 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.

“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.

Tocilizumab is commonly used to treat cytokine release syndrome, a systemic inflammatory response that occurs in response to treatment with certain types of immunotherapies. Dr. Zheng and his team 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.

Dr. Zheng also suggests that because the patient had chest tightness and shortage 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.

The research team hopes this case study may offer insights and stimulate more research. “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 Dr. Zheng.

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

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Blood Advances, is a peer-reviewed, online only, open access journal of the American Society of Hematology (ASH), the world’s largest professional society concerned with the causes and treatment of blood disorders.

Blood Advances® is a registered trademark of the American Society of Hematology.

案例研究：在多發性骨髓瘤患者中治療COVID-19

一項針對中國武漢市患者的案例研究表明，免疫抑製劑托珠單抗可能對患有多發性骨髓瘤和其他血液癌的重病患者可能是一種有效的COVID-19治療。

該報告發表在《血液進展》上，也表明血液癌症患者可能具有非典型的COVID-19症狀。

該患者是一名60歲男性，於2015年被診斷出患有多發性骨髓瘤，目前正在接受維持治療。該患者於2月因胸悶和呼吸急促入院。儘管他沒有表現出咳嗽或發燒症狀，但他的COVID-19測試呈陽性，而且他的病情很嚴重。

抗病毒和皮質類固醇療法的治療不能完全解決他的症狀。在醫院的第二天，胸部CT掃描顯示該患者的肺部有磨砂玻璃混濁，這是肺炎的特徵。他的促炎細胞因子白細胞介素6（IL-6）水平很高。靜脈注射托珠單抗後，患者的IL-6水平下降。托珠單抗治療三天后，他的胸悶消失了。 10天后，他的CT掃描已清除，他已出院。

“我們的血液系統惡性腫瘤患者受到免疫抑制，這可能使他們罹患新型冠狀病毒感染的風險更高。”血液癌患者中COVID-19的特徵是什麼？最佳治療方法是什麼？一切都不知道，這是進行這項研究的動機。”中國科學技術大學的鄭長成博士說。

托珠單抗通常用於治療細胞因子釋放綜合徵，這是一種全身性炎症反應，響應於某些類型的免疫療法的治療而發生。 Zheng博士和他的團隊建議該藥物可以通過解決病毒觸發的急性嚴重炎症反應或“細胞因子風暴”來治療COVID-19。但是，他們強調有必要對潛在的作用機制進行更多研究。

鄭醫生還建議，由於該患者的胸悶和呼吸急促沒有其他COVID-19症狀，特別是咳嗽和發燒，因此該病毒的臨床症狀在血液系統惡性腫瘤患者中可能並不典型。

研究團隊希望這個案例研究可以提供見解並激發更多的研究。鄭博士說：“ Tocilizumab在該多發性骨髓瘤患者中對COVID-19的治療有效，但還需要進一步的前瞻性和隨機臨床試驗來驗證結果。”

2020年3月，FDA批准了一項隨機，雙盲，安慰劑對照的III期臨床試驗，以評估靜脈使用Tocilizumab治療成人COVID-19的安全性和有效性。