According to the American Journal of Managed Care, a case study in China has shown that tocilizumab was effective in treating a patient with both COVID-19 and multiple myeloma. When the 60-year-old patient became sick, tocilizumab assisted in getting him through COVID-19. Read the full findings in Blood Advances.
Multiple Myeloma
Multiple myeloma is a type of cancer that develops in plasma cells. Normally, healthy plasma cells play a role in the immune system by fighting off infections. But in multiple myeloma, cancer cells build in bone marrow. Next, these cancer cells overpower blood cells and start to produce abnormal antibodies called M proteins. Symptoms of multiple myeloma include bone pain, muscle weakness or numbness, nausea, kidney problems, fatigue, unintended weight loss, and hypercalcemia (a condition in which someone has too much calcium). Learn more about multiple myeloma.
The Patient
The patient examined in this study is 60 years old and was first diagnosed with multiple myeloma five years ago. He lives in Wuhan, China. He presented with the following at his diagnosis:
- 17.1% clonal plasma cells in bone marrow – clonal implies cloning, or the development of new cells. In this case, it means that cancerous cells are replicating. The Canadian Cancer Society notes that the bone marrow of healthy individuals only consists of around 2-3% of plasma cells. Anything over 10% is considered multiple myeloma.
- Bone lesions – cancerous lesions on the bone, also suggestive of multiple myeloma.
- Amyloidosis
- Proteinuria – proteinuria means that there were abnormal amounts of protein found in the patient’s urine.
Based on the findings, the patient began 2 cycles of chemotherapy. After, he used thalidomide as maintenance.
COVID-19 & Multiple Myeloma
This year, the patient revisited the hospital in February. He did not have a cough or fever, but was experiencing chest tightness and shortness of breath. Testing showed ground-glass opacities in the lungs, as well as a number of small cysts. The patient eventually tested positive for COVID-19, a novel coronavirus.
Initially, the patient was treated 3x daily with 200mg umifenovir, an antiviral often used to treat the flu. But within 2 weeks, the patient’s condition had devolved. He experienced difficulty breathing and his body was not getting enough oxygen. As a result, the patient was hospitalized.
As COVID-19 spreads, one huge question emerged: how do COVID-19 and cancer interact? While new data still needs to be analyzed, some doctors believe that patients with comorbidities are at higher risk of developing severe COVID-19 reactions. Additionally, this can make it more difficult to ensure effective treatment.
Cytokine Storms
One reason for severe respiratory reactions to COVID-19 is a cytokine storm. This causes inflammation throughout the system, with the immune system over-responding to foreign material. The National Cancer Institute describes cytokine storms as:
a severe immune reaction in which the body releases too many cytokines into the blood too quickly. Cytokines play an important role in normal immune responses, but having a large amount of them released in the body all at once can be harmful.
Cytokine storms can be caused by autoimmune disorders, infections, diseases, or even certain types of drug therapies. Symptoms can be mild, from fatigue, nausea, and inflammation, to severe, like multiple organ failure. Interleukin 6 (IL-6) is one of these cytokines. This pro-inflammatory cytokine responds to infections, but in overly high levels, can harm heart and organ function.
Researchers wondered if treating the overproduction of cytokines could assist patients suffering from severe COVID-19 infections. As such, they treated the patient with tocilizumab, an IL-6 inhibitor. Tocilizumab is also used to treat joint pain, swelling, and associated symptoms of juvenile idiopathic arthritis, rheumatoid arthritis, and giant cell arteritis.
In addition to the patient recovering from COVID-19, researchers found that tocilizumab helped repress cancerous cell growth from multiple myeloma. However, more research and clinical trials need to be performed to determine if these results can be replicated.
