- Patient was intravenously administered 400 mg of moxifloxacin daily for 3 days upon hospitalization for chest tightness and cough
- Nasopharyngeal swab specimens were collected to detect SARS-CoV-2 and RT-PCR revealed a positive result


Pre-COVID-19 Diagnosis

- Upon COVID-19 diagnosis, the patient was given 200 mg of Arbidol orally for 3 days

- Several days later the patient was transferred to the cancer center because of aggravated chest tightness and shortness of breath with arterial oxygen saturation levels (AOSL) at 93%

- Day 1 in cancer center: Patient received oxygen supplementation via cannula (3 L/min) and AOSL increased to 96%

- Days 2-6: 40mg of methylprednisolone were administered intravenously (IV), which improved patient's breathing but did not lessen chest tightness; Chest CT imaging was done on day 2

- Day 8: A second chest CT imaging was done

- Day 9: 8 mg/kg of tocilizumab was administered IV once 

- Day 12: Chest tightness had disappeared

- Day 19: A third chest CT imaging was done
 

Post-COVID-19 Diagnosis

- Pre-COVID-19 diagnosis
- Post-COVID-19 diagnosis

Smith College

University of Michigan - Ann Arbor

In Wuhan, China, the first COVID-19 patient with MM was successfully treated with tocilizumab. MM is a cancer of plasma cells, which are a type of white blood cells that generate antibodies to help the body fight infections. Several studies have shown that tocilizumab, a drug that inhibits Interleukin-6 (IL-6), is able to effectively calm the strong inflammatory response in COVID-19 patients. 

- History of patient diagnosed with COVID-19 and MM
- Methods that were used to treat COVID-19 patient with MM
- Results of the first COVID-19 patient with MM
- Discussion of the first COVID-19 patient with MM

First COVID-19 Patient with Multiple Myeloma (MM) Successfully Treated with Tocilizumab in Wuhan, China 

 - The peak in IL-6 levels after the initial decrease does not suggest COVID-19 relapse; in fact, this occurrence can be attributed to the recovery of nomral T cells

- The patient did not exhibit typical symptoms of COVID-19 such as fever and cough but experienced chest tightness and shortness of breath; this suggests that typical symptoms of COVID-19 are not present in patients with coexisting comorbidities such as multiple myleoma (MM)

- The patient's condition slowly recovered after tocilzumub treatment, suggesting that tocilizumab is an effective treatment of COVID-19

- IL-6 signaling plays a key role in the pathogenesis of MM and thus small molecule inhibitors that target this are extremely effective at stopping MM cell growth; the investigators believe that tocilizumab might also prove to be a useful therapeutic for MM 

- Overall, this study is the first to report that tocilizumab is an effective treatment for COVID-19 patients also diagnosed with MM


Discussion of the First COVID-19 Patient with Multiple Myeloma Successfully Treated with Tocilizumab in Wuhan, China

- 60-year-old working male
- Diagnosed with multiple myeloma on May 12, 2015
- Received 2 cycles of induction chemotherapy comprising of bortezomib, thalidomide, and dexamethasone, which caused his symptoms to disappear
- Refused further bortezomib-based treatment and only took thalidomide for maintenance


Patient History of the First COVID-19 Patient with Multiple Myeloma Successfully Treated with Tocilizumab in Wuhan, China

- Day 2: Chest CT imaging revealed bilateral, multiple ground-glass opacities (GGO) (Images A-C)

- Day 8: Chest CT imaging revealed that the bilateral, multiple GGO from the first scan were still present (Images D-F); laboratory investigations conveyed a high level of serum IL-6

- Post tocilizumab treatment (after day 9), IL-6 level decreased slowly over a period of 10 days from 121.59 to 20.81 pg/mL, then peaked to 317.38 pg/mL, and then decreased to 117.10 pg/mL. 

- Day 19: Chest CT imaging reveled that the range of GGO had decreased (Images G-I)

- Soon after, patient was cured of COVID-19 and discharged from hospital; patient did not exhibit symptoms of MM


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