Clinical Advances in Hematology & Oncology

May 2020 - August 2024 - Volume 18, Issue 5

COVID-19 in HEM/ONC News

Devon Schuyler

Tocilizumab May Help Patients With COVID-19 and Myeloma

The immunosuppressant tocilizumab (Actemra, Genentech) may be an effective treatment for severe coronavirus disease 2019 (COVID-19) in patients with multiple myeloma, according to a case report from Wuhan, China. 

The case report by Dr Xuhan Zhang and colleagues at the University of Science and Technology of China in Hefei, which appeared online in Blood Advances on April 3, described a 60-year-old man who was receiving maintenance treatment for multiple myeloma. He was admitted to the hospital in February after developing chest tightness and shortness of breath. Although he had no fever or cough, he tested positive for COVID-19. A chest computed tomography (CT) scan revealed ground-glass opacities, and the patient began antiviral and corticosteroid treatment. 

After 9 days in the hospital, the patient still had chest tightness, and laboratory testing revealed a high level of serum interleukin 6 (IL-6). The patient received a single intravenous dose of tocilizumab, which blocks IL-6, and the chest tightness disappeared 3 days later. A chest CT scan 10 days after tocilizumab administration showed a reduction in ground-glass opacities, and the patient was discharged after a month in the hospital. 

The authors concluded that tocilizumab was effective in treating this patient, and speculated that the agent “might also have potential benefit” as immunotherapy for myeloma in the future. 

The phase 3 COVACTA trial is evaluating the use of tocilizumab in patients with severe COVID-19 pneumonia (NCT04320615).

 

Approximately 2% of COVID-19 Patients Also Have Cancer

Approximately 2% of patients with COVID-19 also have cancer, according to a recent meta-analysis by Dr Aakash Desai of the University of Connecticut in Farmington and colleagues. This stands in contrast with the 1% prevalence found in an earlier report by Dr Wenhua Liang and colleagues at Guangzhou Medical University in China. 

The recent meta-analysis, which appeared online April 6 in JCO Global Oncology, included data on 3461 patients from 11 studies. The researchers found that the overall pooled prevalence of cancer in COVID-19 patients was 2.0%. A subgroup analysis revealed a prevalence of 3.0% among the 5 studies with no more than 100 patients, and 2.0% among the 6 studies with more than 100 patients. 

The earlier study, which was published online February 14 in Lancet Oncology, examined data on 1590 patients. The researchers found that cancer patients were overrepresented among those diagnosed with COVID-19, making up 1.0% of this population vs 0.29% of the overall population in China. Furthermore, COVID-19 patients who had cancer were at increased risk for dying or needing mechanical ventilation. 

The authors cautioned that their data were “potentially limited by the retrospective nature of the studies used,” but underscore the fact that large numbers of patients with cancer and cancer survivors are at risk for COVID-19. 

 

Case Report Links COVID-19 to Bleeding, Clotting Abnormalities

Patients with COVID-19 may develop coagulopathy, antiphospholipid antibodies, and multiple infarcts, according to a case report that was published online April 8 by the New England Journal of Medicine. Although the report described a single patient, Dr Yan Zhang and coauthors at Peking Union Medical College Hospital in Beijing, China, noted 2 additional patients with these findings in their intensive care unit for patients with COVID-19. 

The patient, a 69-year-old man with a history of hypertension, diabetes, and stroke presented with fever, cough, dyspnea, diarrhea, and headache. Testing confirmed a diagnosis of COVID-19, which eventually required mechanical ventilation. 

The man also had evidence of ischemia in the lower limbs and in 2 digits of the left hand, and a CT scan of the brain revealed cerebral infarcts in multiple vascular territories. Laboratory tests showed leukocytosis, thrombocytopenia, elevated prothrombin time and partial thromboplastin time, and elevated fibrinogen and D-dimer. 

The authors noted that the presence of antiphospholipid antibodies, which often reflect antiphospholipid syndrome, “can also arise transiently in patients with critical illness and various infections.” 

 

COVID-19–Specific Resources

• The National Comprehensive Cancer Network has posted a variety of new resources on best practices for ensuring cancer patient and provider safety during the COVID-19 pandemic. (www.nccn.org/covid-19) 

• The American Society of Clinical Oncology has compiled a wide range of resources to support clinicians, the cancer care delivery team, and patients with cancer. (www.asco.org/asco-coronavirus-information)

• The American Society of Hematology is maintaining a list of resources to assist hematologists in navigating the pandemic. (www.hematology.org/covid-19)