Special case of a patient in the blast phase of chronic myeloid leukemia successfully treated with tocilizumab during critical SARS-CoV-2 infection

Bouchlarhem, Amine; Es-saad, Ounci; Haddar, Leila; Lamzouri, Oussama; Elaidouni, Ghizlane; Mimouni, Hamza; Bkiyar, Houssam; Housni, Brahim

doi:10.1177/03000605221082875

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…Mivel a betegség progressziója nagyban összefügg a mikrokörnyezeti változásokkal, további terápiás megközelítésként alkalmazhatunk angiogenezis-gátló szereket, inflammatorikus citokinek ellen célzott antitesteket (például IL6-ellenes tocilizumab) és a károsodott immunválasz helyreállítását segítő 'checkpoint' inhibitorokat (például nivolumab, pembrolizumab, atezolizumab) [30][31][32].…”

Section: Kezelés Relapsus Refrakteritás Eseténunclassified

Az elérhető gyógyulás küszöbén: innovációk a myeloma multiplex kezelésében

Tóth,

Alizadeh

2024

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A myeloma multiplex diagnosztikája és kezelése terén jelentős előrelépések történtek az elmúlt évek során. Az immunmoduláns ágensek, a proteaszómagátlók és a nagy dózisú melfalánnal való kondicionálást követő autológ haemopoeticus őssejt-transzplantáció bevezetése lehetővé tette a mélyebb terápiás válasz és a hosszabb távú túlélés elérését. Ennek ellenére a szakirodalom továbbra is a betegség gyógyíthatatlanságát hangsúlyozza, mivel a remissziók és a relapsusok váltakozása továbbra is meghatározza a kórkép lefolyását. A myeloma multiplex esetében a definitív gyógyuláshoz elengedhetetlen a gyógyszer-rezisztencia leküzdése és a tartós válasz biztosítása. Ennek eléréséhez új terápiás stratégiák kidolgozására és érzékenyebb diagnosztikus eszköztárra van szükség. Közleményünk célja a jelenleg alkalmazott kezelési irányelvek áttekintése mellett az új diagnosztikus eljárások és a klinikai vizsgálatokban szereplő terápiás stratégiák összefoglalása, melyek javíthatják a betegek életminőségét és túlélési esélyeit. A modern diagnosztikus módszerek lehetővé teszik a betegség korai felismerését, a személyre szabott, biológiai alapú kezelések bevezetését és a válaszadaptált terápia alkalmazását. Továbbá az immunterápiás stratégiák korábbi kezelési vonalakba való beépülése a jövőben megkérdőjelezheti a betegség gyógyíthatatlanságáról kialakított elképzeléseket. Orv Hetil. 2024; 165(23): 891–899.

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Section: Kezelés Relapsus Refrakteritás Eseténunclassified

Az elérhető gyógyulás küszöbén: innovációk a myeloma multiplex kezelésében

Tóth,

Alizadeh

2024

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“…The lack of standardized reference guidelines for the indications, timing, dosage and combination therapy of tocilizumab across diverse studies has contributed to varying conclusions. In several case reports (Zhang et al, 2020;Bouchlarhem et al, 2022), the addition of IL-6 pathway inhibitor (tocilizumab) to glucocorticoids improved hypoxia and prognosis in HM patients (including those with CML or MM) with severe COVID-19, and short-term use would not increase the risk of secondary infection (Frigault et al, 2020). But in a retrospective study (Garcıá-Suaŕez et al, 2020) involving 692 patients with HM and COVID-19, 318 (46%) patients received systemic corticosteroids and 132 (19%) patients received tocilizumab.…”

Section: Cytokine Receptor Antagonistmentioning

confidence: 99%

Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes

Guo,

Zheng,

Feng

2023

Front. Cell. Infect. Microbiol.

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The Omicron variant of SARS-CoV-2 has rapidly become the dominant strain worldwide due to its high transmissibility, although it appears to be less pathogenic than previous strains. However, individuals with hematological malignancy (HM) and COVID-19 remain susceptible to severe infection and mortality, especially those with chronic lymphocytic leukemia (CLL) and those undergoing chimeric antigen receptor T-cell (CAR-T) treatment. Hematologists should thoroughly assess the severity of the patient’s hematological disease and the potential risk of SARS-CoV-2 infection before initiating chemotherapy or immunosuppressive treatment. Vaccination and booster doses are strongly recommended and patients with a poor vaccine response may benefit from long-acting COVID-19 neutralizing monoclonal antibodies (such as Evusheld). Early use of small molecule antiviral drugs is recommended for managing mild COVID-19 in HM patients and those with severe immunodeficiency may benefit from SARS-CoV-2 neutralizing monoclonal antibody therapy and high-titer COVID-19 convalescent plasma (CCP). For moderate to severe cases, low-dose glucocorticoids in combination with early antiviral treatment can be administered, with cytokine receptor antagonists or JAK inhibitors added if the condition persists or worsens. In the treatment of hematological malignancies, delaying chemotherapy is preferable for CLL, acute leukemia (AL), and low-risk myelodysplastic syndrome (MDS), but if the disease progresses, appropriate adjustments in dosage and frequency of treatment are required, with the avoidance of anti-CD20 monoclonal antibody, CAR-T and hematopoietic stem cell transplantation (HSCT). Patients with chronic myelocytic leukemia (CML) and myeloproliferative neoplasms (MPNs) can continue current treatment. What’s more, non-drug protective measures, the development of new vaccines and antiviral drugs, and monitoring of mutations in immunocompromised populations are particularly important.

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“…Hematologic malignancy patients usually have severe immunodeficiency due to the underlying disease and chemotherapy. 1 Some patients also receive treatments such as chimeric antigen receptor T cell (CAR-T) therapy and hematopoietic stem cell transplantation, contributing to their unique immunological status compared to non-hematologic malignancy patients. 2 Those patients are much more likely to develop severe situations after COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

Using Tocilizumab in Hematologic Malignant Patients with Severe COVID-19 Infection – Case Series Report

Fu,

Zhu,

Huang

et al. 2024

IDR

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Background Patients with hematologic malignancies usually have severe immunodeficiency and are much more likely to be severe after COVID-19 infection. Tocilizumab is a monoclonal antibody of interleukin-6 (IL-6) and is recommended for treating severe conditions in the latest COVID-19 treatment guidelines. However, the efficacy and safety of tocilizumab in hematologic malignancy patients have yet to be clarified. We report five hematologic malignancy patients with severe COVID-19 infection who were all successfully recovered with tocilizumab treatment. Methods We reported five hematologic malignant patients who developed severe COVID-19 infection and received tocilizumab at the First Affiliated Hospital of Zhejiang University School of Medicine during the COVID-19 pandemic in China from Dec 2022 to Mar 2023. We observed the effect of tocilizumab on COVID-19 infection and evaluated its safety. Results Five hematologic malignancy patients with severe COVID-19 infection were retrospectively enrolled. The dosage of tocilizumab was 400–480mg once; one patient used a second dose of tocilizumab on the third day of medication. After receiving tocilizumab treatment, all five patients experienced a rapid decrease in body temperature and C-reactive protein (CRP) within 24 hours and improved oxygen requirement within one to three days (one patient did not experience hypoxia). Chest CT scans after one week showed absorption of lung infection. The serum IL-6 levels of three patients showed an initial increase followed by a decrease. None of the patients experienced grade 3–4 hematologic or non-hematologic toxicity. Conclusion Tocilizumab can improve the outcome of severe COVID-19 infection in hematologic malignancy patients with severe immunodeficiency without severe adverse reactions.

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Special case of a patient in the blast phase of chronic myeloid leukemia successfully treated with tocilizumab during critical SARS-CoV-2 infection

Cited by 5 publications

References 13 publications

Az elérhető gyógyulás küszöbén: innovációk a myeloma multiplex kezelésében

Az elérhető gyógyulás küszöbén: innovációk a myeloma multiplex kezelésében

Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes

Using Tocilizumab in Hematologic Malignant Patients with Severe COVID-19 Infection – Case Series Report

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