Clinical course of severe COVID19 treated with tocilizumab and antivirals post-allogeneic stem cell transplant with extensive chronic GVHD

Transpl Infect Dis. 2021 Aug;23(4):e13576. doi: 10.1111/tid.13576. Epub 2021 Feb 18.

Abstract

Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are an immunocompromised group who are likely to develop severe complications and mortality because of coronavirus disease 2019 (COVID-19). We report here a 61-year-old male patient of primary myelofibrosis who underwent an allo-HSCT 6 years earlier, had chronic graft-versus-host disease (cGVHD) involving the liver, lung, eyes, and skin, (with recurrent episodes of pulmonary infections) who developed severe COVID-19. The patient was treated with tocilizumab, and a combination of lopinavir/ritonavir, ribavirin, interferon-β1b. He was discharged after 31 days with full recovery. Tocilizumab, a humanized monoclonal antibody against IL6, has been shown to benefit respiratory manifestations in severe COVID19. However, this is first report, to our knowledge, of its use and benefit in a post HSCT recipient.

Keywords: GVHD; allogeneic; coronavirus disease (COVID19); stem cell transplant; tocilizumab.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents / therapeutic use
  • COVID-19 Drug Treatment*
  • Graft vs Host Disease* / drug therapy
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Male
  • Middle Aged
  • SARS-CoV-2
  • Stem Cell Transplantation / adverse effects

Substances

  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • tocilizumab