Use of Tocilizumab in Management of Post-Operative Myelomonocytic Leukemoid Reaction

Abstract

Interleukin 6 receptor (IL6R) inhibitor, tocilizumab, has been effectively used in the treatment of cytokine release syndrome in patients receiving chimeric antigen receptor T-cell therapy. Here we present a patient with chronic myelomonocytic leukemia (CMML) who developed a steroid refractory, post-operative myelomonocytic leukemoid reaction (PO-MMLR), effectively treated with tocilizumab. Although, further studies are needed to validate the effectiveness of tocilizumab in management of PO-MMLR, this case serves to provide a new management approach in treatment of this rare but lethal syndrome with no standardized treatment options.

Post-operative hyperleukocytosis and leukostasis as the initial presentation of chronic myelomonocytic leukemia: A case report and review of literature.

“…One patient was initially treated with tocilizumab and authors report transient improvement in clinical condition, followed again by deterioration. Treatment with hydroxyurea was then initiated, however, patient did not survive [ 14 ].Pathophysiology of leukostasis is complex and there is poor correlation between leukocyte count and clinical outcomes. CMML is characterized by the expansion of the CD14+/CD16- classical monocytes at the expense of intermediate (CD14+CD16+) and non-classical (CD14-CD16+) subtypes [17] .…”

“…At the time of exam, her blood pressure was 106/62 mmHg, pulse rate 123/min, respiratory rate 16/min and temperature of 36.3 °Celsius. Glasgow coma scale was [14] . She had right sided facial droop and right pronator drift.…”